腹腔镜联合胃镜与开腹手术治疗胃间质瘤的临床研究

Clinical study on laparoscopic-endoscopic cooperative surgery and open resection for gastrointestinal stromal tumor of stomach

目的：探讨腹腔镜联合胃镜治疗胃GIST的安全性、可行性及近期临床疗效，并与开腹手术比较预后情况。方法：回顾分析我院2010年1月至2013年1月收治的68例胃GIST病人．行腹腔镜联合胃镜胃GIST切除术36例（双镜组），开腹胃GIST切除术32例（开腹组），分析两组病人的围手术期资料、病理及肿瘤复发情况等。结果：两组病人平均手术时间双镜组（83．8±32．0）min明显少于开腹组（161．1±59．5）min（P〈0．001）。局部切除率（GIST切除与胃楔形切除例数／各组总病例数）双镜组（33／36，91．7％）高于开腹组（23／32，71．9％）（P＜0．05）。术中出血量分别为32（20-300）mL和100（10-800）mL，双镜组出血明显较少（RO．001）。双镜组病人术后肠道功能恢复（恢复半流质饮食）时间较短[5（3-11）d比10（6～35）d]（P〈0．001），术后住院时间也较短[7（6～16）d比12（9-53）d]（P〈O．001）。术后并发症发生率双镜组为5．6％，开腹组为12．5％眇0．05）。双镜组随访32例（88．9％），中位随访时间22（7。34）个月；开腹组随访29例（90．6％），中位随访时间26（10～40）个月。两组均无死亡病例。复发率分别为3．1％（1／32）和3．4％（1／29）（P〉0．05）。结论：腹腔镜联合胃镜手术对直径〈10cm的胃GIST能取得与开腹手术同样的效果，且具有手术时间短、术中出血少、术后恢复快等优势。

Objective To evaluate the feasibility and clinical value of laparoscopic-endoscopic cooperative resection （LECS） for gastric GIST and to compare the outcomes with open resection. Methods From January 2010 to January 2013, 68 patients with gastric GIST in LECS group （36 cases） and in open group （32 cases） were analyzed retrospectively. The perioperative data, pathological results and tumor recurrence were compared. Results Operative time was significantly less in LECS group [（83.8±32.0） min] than in open group [（161.1±59.5） min] （P〈0.001）. More patients in LECS group underwent segmental or wedge resection than in open group [33/36（91.7%） vs 23/32（71.9%）, P〈0.05]. Compared with open group, the LECS also had less blood loss [32 （20-300） mL vs 100 （10~800） mL, P〈0.001], earlier recovery for bowel function [5（3-11） days vs 10 （6~35） days, P〈0.001], and shorter postoperative hospital stay [7（6-16） days vs 12（9~53） days, P〈0.001]. No significant differences were found between LECS group and open group in postoperative complications （5.6% vs 12.5%, P〉0.05）. Thirty-two （88.9%） cases were followed up in LECS group for the duration of a mean of 22 （7-34） months, and 29 （90.6%） cases in open group for 26 （10-40） months. There was no mortality in both groups. No difference existed for the recurrence rate between the two groups [1/32 （3.1%） vs 1/29 （3.4%）, P〉0.05]. Conclusion~ LECS has similar, effect when compared with open resection for surgical treatment of gastric GIST of size smaller than 10 cm with shorter time of operation, less blood loss and fast recovery from operation.