双镜联合手术治疗胃间质瘤93例疗效分析

Effect of laparoscopy combined with endoscopy in the treatment of gastric stromal tumor:An analysis of 93 cases

目的：探讨腹腔镜联合电子胃镜（双镜联合）手术治疗胃间质瘤（gastric stromal tumors，GST）的安全性及可行性。方法回顾性分析兰州军区兰州总医院普通外科2005年8月至2013年8月行手术治疗93例GST病人的临床资料。其中行双镜联合治疗GST 41例（双镜联合组），传统开腹手术52例（开腹组）。结果所有手术均顺利完成,无中转开腹及术中死亡，双镜联合组手术时间[（66.3±9.2）min vs.（126.0±8.7）min]、术中出血量（37.0±8.9）mL vs.（107.7±15.4）mL]、术后胃肠道功能恢复时间[（2.7±0.6）d vs.（3.1±0.5）d]、术后下床时间[（0.9±0.3）d vs.（1.8±0.5）d）、进半流质食物时间[（2.6±0.5）d vs.（3.0±0.4）d]、术后住院时间[（7.8±2.4）d vs.（10.0±2.7）d]、术后并发症发生率（2.4%vs.15.4%）均显著低于开腹组（P值均〈0.05），双镜联合组术后随访时间（6~36）个月，术后1年存活率为97.4%（37/38），3年存活率为89.5%（17/19），开腹组随访时间36个月，术后1年存活率为95.7%（44/46），3年存活率为84.8%（39/46），两组存活率差异无统计学意义（P＞0.05）。结论双镜联合治疗GST是一种安全、可行的精准微创手术方法，能取得良好的近、远期治疗效果。

Objective To explore the safety and feasibility of laparoscopy combined with electronic endoscopy in treatment of gastric stromal tumor （GST）. Methods The clinical data of 93 cases of GST performed surgery from August 2005 to August 2013 in Department of General Surgery, General Hospital of Lanzhou Military Command of PLA were analyzed retrospectively. Among them, 41 cases were treated by laparoscopy and electronic endoscopy, and 52 cases by conventional open operation. Results All the operations were completed successfully without conversion to laparotomy or intraoperative death. Compared to the open group , the observation group was lower significantly in operation time [（66.3±9.2） min vs. （126.0±8.7） min], intraoperative bleeding [（37.0±8.9）mL vs. （107.7±15.4） mL], the recovery time of gastrointestinal function after operation [（2.7 ± 0.6） d vs. （3.1 ± 0.5） d], getting out of bed after operation[（0.9 ± 0.3） d vs. （1.8 ± 0.5）d）, semi liquid food time [（2.6 ± 0.5）d vs.（3.0 ± 0.4）d], the hospitalization time after operation [（7.8 ± 2.4）d vs. （10.0±2.7）d], the incidence of postoperative complications （2.4%vs 15.4%） （P〈0.05）. After a follow-up （6-36 months）, the 1 and 3 year survival rates of observation group after operation was 97.4%（37/38） and 89.5%（17/19） respectively. After a follow-up of 36 months for the open group, the 1 year survival rate was 95.7%（44/46）, and the 3 year survival rate was 84.8% （39/46）. There was no significant difference between the two groups in survival rate （P 〉 0.05）. Conclusion Laparoscopy combined with endoscopy in treatment of GST is a safe, feasible, minimally invasive and accurate operation, which can get good effects in short and long term results.