套扎器辅助内镜黏膜下剥离术治疗2 cm以内胃肠间质瘤患者的效果及对胃肠功能、免疫功能及预后的影响  

Efficacy of ligation device-assisted endoscopic submucosal dissection in treating gastrointestinal stromal tumors≤2 cm and its impact on gastrointestinal function,immune function,and prognosis

作　　者：杨君丽 孙宗强[1] 刘奇峰[1] 张西亮[1] YANG Jun-li;SUN Zong-qiang;LIU Qi-feng;ZHANG Xi-liang(Department of Gastroenterology,Shangqiu First People's Hospital,Shangqiu 476100,Henan,CHINA)

机构地区：[1]商丘市第一人民医院消化内科,河南商丘476100

出　　处：《海南医学》2025年第7期953-957,共5页Hainan Medical Journal

基　　金：2020年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20200581)。

摘　　要：目的探讨套扎器辅助内镜黏膜下剥离术(ESD)术治疗2 cm以内胃肠间质瘤(GIST)患者的效果及对胃肠功能、免疫功能及预后的影响。方法选取2021年6月至2023年6月商丘市第一人民医院收治的83例最大直径2 cm以内的GIST患者作为研究对象,按随机数表法分为对照组41例和研究组42例,对照组患者采用ESD术治疗,研究组患者采用套扎器辅助ESD术治疗,治疗出院后均随访12个月。比较两组患者的手术情况(术中出血量、手术时间、术中穿孔率、肿瘤切除率)以及术前和术后3 d的胃动素、胃泌素及免疫功能(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)),同时比较两组患者随访12个月的预后情况。结果研究组患者术中出血量、手术时间分别为(14.86±2.42)m L、(18.18±2.01)min,明显少(短)于对照组的(31.39±3.10)m L、(35.02±3.70)min,术中穿孔率为0,明显低于对照组的9.76%,肿瘤切除率为100.00%,明显高于对照组的87.80%,差异均有统计学意义(P<0.05)。术前,两组患者的胃动素、胃泌素和免疫功能比较差异均无统计学意义(P>0.05);术后3 d,两组患者的胃动素、胃泌素、CD4^(+)、CD4^(+)/CD8^(+)均降低,CD8^(+)均上升,且研究组患者的胃动素、胃泌素、CD4^(+)、CD4^(+)/CD8^(+)分别为(121.50±15.83)ng/L、(80.50±7.64)ng/L、(44.20±4.71)%、1.48±0.10,明显高于对照组的(90.74±10.26)ng/L、(63.11±6.52)ng/L、(40.33±5.42)%、1.35±0.11,CD8^(+)为(29.65±2.18)%,明显低于对照组的(32.17±2.40)%,差异均有统计学意义(P<0.05)。随访12个月,两组患者均无发生远处转移和复发。结论套扎器辅助ESD术治疗2 cm以内GIST的手术创伤更小,且能降低穿孔风险,对患者的胃肠功能及免疫功能的影响较小,利于改善预后。Objective To investigate the efficacy of ligation device-assisted endoscopic submucosal dissection(ESD)in treating gastrointestinal stromal tumors(GIST)≤2 cm and its impact on gastrointestinal function,immune function,and prognosis.Methods A total of 83 patients with GIST≤2 cm in maximum diameter admitted to Shangqiu First People's Hospital from June 2021 to June 2023 were selected as the study subjects.They were divided into a control group(41 cases)and a study group(42 cases)using a random number table.The control group was treated with conventional ESD,while the study group received ligation device-assisted ESD.All patients were followed up for 12 months after discharge.Surgical outcomes(intraoperative bleeding,operation time,intraoperative perforation rate,tumor resection rate),gastrointestinal function(motilin,gastrin),and immune function(CD4^(+),CD8^(+),CD4^(+)/CD8^(+))were compared between the two groups before and 3 days after surgery.Additionally,the prognosis of the two groups was compared during the 12-month follow-up.Results The intraoperative bleeding volume and operation time in the study group were(14.86±2.42)mL and(18.18±2.01)min,respectively,significantly lower(shorter)than(31.39±3.10)mL and(35.02±3.70)min in the control group.The intraoperative perforation rate in the study group was 0,significantly lower than 9.76%in the control group,and the tumor resection rate in the study group was 100.00%,significantly higher than 87.80%in the control group,with statistically significant differences(P<0.05).Before surgery,there were no significant differences in motilin,gastrin,or immune function between the two groups(P>0.05).Three days after surgery,motilin,gastrin,CD4^(+),and CD4^(+)/CD8^(+)levels decreased in both groups,while CD8^(+)levels increased.The study group's motilin,gastrin,CD4^(+),and CD4^(+)/CD8^(+)levels were(121.50±15.83)ng/L,(80.50±7.64)ng/L,(44.20±4.71)%,and 1.48±0.10,respectively,significantly higher than(90.74±10.26)ng/L,(63.11±6.52)ng/L,(40.33±5.42)%,and 1.35±0.11 in

关 键 词：小胃肠间质瘤 套扎器 内镜黏膜下剥离术 胃肠功能 免疫功能 预后 

分 类 号：R735[医药卫生—肿瘤]