内镜与腹腔镜切除胃间质瘤的临床对比研究

Comparison between endoscopy and laparoscopy in resection of gastric stromai tumor

目的通过与腹腔镜治疗有效性和安全性的对比，探讨无腹腔镜辅助下内镜切除胃间质瘤的临床应用价值。方法回顾性收集肿瘤直径〈3．0em且边界清晰的胃间质瘤患者92例，其中53例独立行内镜下切除（内镜组），39例独立行腹腔镜切除（腹腔镜组），对比分析2组手术耗时、术中出血量、术后胃管留置时间、术后通便时间、术后住院时间、术后并发症、复发率和转移率。结果内镜组与腹腔镜组比较，手术耗时短[50（48～58）min比70（50～95）rain，U=1575．00，P〈0．01]，术中出血量少[10（5—15）ml比20（20—30）ml，U=1794．00，P〈0．01]，术后通便早[18（8～36）h比24（20—40）h，U=1666．00，P〈0．01]，而在术后胃管留置时间、术后住院时间、术后并发症等方面差异均无统计学意义（P〉0．05）。内镜组术后随访（27±15）个月，腹腔镜组术后随访（24±11）个月，2组随访时间差异无统计学意义（t=0．3084，P〉0．05），随访期间均未见胃间质瘤复发和转移，亦无因胃间质瘤而死亡的病例。结论对于直径〈3．0em且边界清晰的胃间质瘤行内镜下独立切除是安全可行的，与腹腔镜手术疗效相近，且创伤更小、恢复更快。

Objective To compare the feasibility and safety of endoscopy with laparoscopy and without for gastric stromal tumor. Methods A retrospective and comprehensive analysis was made based on the clinical data of endoscopic （53 cases ） and laparoscopic （39 cases ） resection for gastric stromal tumor （diameter 〈 3 cm with clear boundary）, by comparing the operation time, intraoperative blood loss, indwell- ing time of postoperative gastric tube, recovery time of bowel functions, postoperative complications, hospi- talization time, metastasis, recurrence rate. Results Compared with the laparoscopic group, the endoscopic group required shorter operation time [ 50 （48-58） min VS 70 （ 50-95 ） min, U = 1575.00, P 〈 0. 01 ], less intraoperative blood loss [ 10 （ 5-15 ） ml VS 20 （20-30） ml, U = 1794.00, P 〈 0. 01 ], earlier recovery of bowel functions [ 18 （8-36） h VS 24 （20-40） h, U = 1666.00, P 〈 0. 01 ], hospitalization time, indwelling time of the postoperative gastric tube and postoperative complications showed no statistical difference （ P 〉 0. 05 ）. The postoperative follow-up time were （27 ±15 ） and （24 ± 11 ） months in the endoscopic and lapa- roscopic group, respectively （t = 0. 3084, P 〉 0. 05）. During the follow-up, no tumor recurrence or distant metastasis was discovered, nor was death of gastric stromal tumor. Conclusion Endoscopy without the as- sist of laparoscopy for the gastric stromal tumor, whose diameter is less than 3 cm with clear boundary, is safe and less invasive, and leads to quick recovery.