内镜下套扎术联合黏膜下剥离术与内镜下黏膜下剥离术治疗胃肠道间质瘤的疗效比较

Efficacy comparasion of endoscopic band ligation combined with submucosal dissection and endo-scopic submucosal dissection in treatment of gastrointestinal stromal tumors

目的：探讨内镜下套扎术联合黏膜下剥离术与内镜下黏膜下剥离术治疗胃肠道间质瘤（ GIST）的疗效。方法收集2008年2月至2013年10月齐河县人民医院确诊并进行手术治疗的32例胃肠道间质瘤患者的临床资料，根据微创术方法分为套扎术联合黏膜下剥离术组和单纯黏膜下剥离术两组。记录两组患者的瘤体切除情况、出血量、穿孔情况、术后胃肠功能恢复时间、并发症情况、住院费用及住院时间等指标。结果套扎术联合黏膜下剥离术组完全切除率显著高于单纯内镜下黏膜下剥离术组，差异有统计学意义（χ^2＝4.431，P＝0.035），而出血量、穿孔率、并发症发生率、住院费用及住院时间显著低于单纯内镜下黏膜下剥离术组，差异有统计学意义（t＝7.674，P〈0.001；χ^2＝4.693，P＝0.030；t＝1.021，P＝0.077；χ^2＝4.569，P＝0.033；t＝3.874，P＝0.029；t＝2.739， P＝0.041）。结论将套扎术和黏膜下剥离术结合起来可以扬长避短，获得较好的治疗效果，但还需要对患者进行长期随访，以确定内镜下联合治疗的可适用性及推广性。

Objective To investigate the efficacy of endoscopic band ligation combined with submucosal dissection and endoscopic submucosal dissection on gastrointestinal stromal tumors. Methods From February 2008 to October 2013 ,the clinical data of 32 patients with gastrointestinal stromal tumors underwent operation in our hospital were collected and according to the method of minimally invasive surgery,the patients were divided into endoscopic band ligation combined with submucosal dissection group and endoscopic submucosal dissection group. The indexes including tumors resection,bleeding volume,perforation,postoperative gastrointestinal function,recovery time,complications,expenditure,and hospital stays were recorded. Results Compared with endo-scopic submucosal dissection,endoscopic band ligation combined with submucosal dissection had higher removal rate（χ^2 =4. 431,P=0. 035）. There were significantly differences in bleeding volume,perfora-tion,postoperative gastrointestinal function,recovery time,complication,expenditure and hospital stays （ t=7. 674 ,P〈0. 001;χ^2 =4. 693 ,P=0. 030;t=1. 021 ,P =0. 077;χ^2 =4. 569 ,P =0. 033;t=3. 874 ,P=0. 029;t=2. 739 ,P=0. 041 ）. Conclusions Endoscopic band ligation combined with sub-mucosal dissection has good curative effect. Long-term follow-up is needed to determine the applicability and popularization of endoscopic combination therapy.