胃困难部位间质瘤内镜与腹腔镜治疗临床疗效比较  

Comparison of clinical effects between endoscopic and laparoscopic treatment of stromal tumors in difficult gastric sites

作　　者：赵敏[1] 谭韡[1] 罗和生[1] ZHAO Min;TAN Wei;LUO Hesheng(Department of Gastroenterology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院消化内科,湖北武汉430060

出　　处：《胃肠病学和肝病学杂志》2023年第5期499-504,513,共7页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的比较内镜手术[内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)或内镜下全层切除术(endoscopic full thickness resection,EFTR)]和腹腔镜手术治疗胃困难部位间质瘤的安全性和有效性。方法回顾性分析我院2017年1月至2021年12月行内镜下治疗和腹腔镜治疗的位于胃困难部位且术后病理证实为胃肠道间质瘤患者的临床资料,比较两组患者的基线资料、手术安全性、短期预后及随访结果。结果共纳入64例患者,30例行内镜下治疗,34例行腹腔镜治疗。腹腔镜组肿瘤直径(3.51±0.80)cm大于内镜组(2.88±0.80)cm,差异有统计学意义(P<0.01),两组患者性别、年龄、首发症状、个人史、肿瘤部位、肿瘤危险度、核分裂象、术后辅助治疗情况比较,差异均无统计学意义(P>0.05)。内镜组患者术后进食时间早于腹腔镜组[(3.1±0.5)d vs(5.4±2.0)d,P<0.01],术后住院时间短于腹腔镜组[(6.8±1.3)d vs(9.6±4.1)d,P=0.001],两组患者手术整块切除率(86.7%vs 91.2%)、R0切除率(100%vs 100%)、术后并发症发生率(6.9%vs 9.7%)以及发生并发症患者手术部位的比较,差异均无统计学意义(P>0.05)。两组患者随访期间均无复发和转移病例。结论在经验丰富的医疗中心对胃困难部位间质瘤行腹腔镜手术和内镜手术均安全可行,且内镜手术较腹腔镜手术具有手术创伤小、恢复快、术后进食时间早、住院时间短的优势。Objective To compare the safety and efficacy of endoscopic and laparoscopic treatment of stromal tumors in difficult gastric sites.Methods The clinical data of patients with gastrointestinal stromal tumors who underwent endoscopic treatment or laparoscopic treatment in our hospital and located in difficult gastric sites were retrospectively collected from Jan.2017 to Dec.2021.The baseline data,surgical safety,short-term prognosis and follow-up results of the two groups of patients were compared.Results A total of 64 patients were included,30 patients underwent endoscopic treatment,and 34 patients underwent laparoscopic treatment.The average tumor diameter of patients in the laparoscopic group(3.51±0.80)cm was larger than that of endoscopic group(2.88±0.80)cm,the difference was statistically significant(P<0.01).There were no significant differences in gender,age,initial symptoms,personal history,tumor sites,tumor risk,mitotic figures and postoperative adjuvant therapy between the two groups(P>0.05).The postoperative eating time of the patients in the endoscopic group was earlier than that in the laparoscopic group[(3.1±0.5)d vs(5.4±2.0)d,P<0.01],and the postoperative hospital stay was shorter than that in the laparoscopic group[(6.8±1.3)d vs(9.6±4.1)d,P=0.001],there was no significant difference in the en bloc resection rate(86.7%vs 91.2%),R0 resection rate(100%vs 100%),postoperative complication rate(6.9%vs 9.7%)and the surgical site of patients with complications between the two groups(P>0.05).There were no cases of recurrence and metastasis during follow-up in the two groups.Conclusion Both laparoscopic and endoscopic surgery are safe and feasible for gastric stromal tumors located in difficult gastric sites in experienced medical centers,and compared with laparoscopic surgery,endoscopic surgery has the advantages of less surgical trauma,faster recovery,earlier postoperative eating time,and shorter hospitalization time.

关 键 词：胃肠道间质瘤 内镜下治疗 腹腔镜手术 治疗效果 

分 类 号：R735.2[医药卫生—肿瘤]