腹腔镜与开腹手术治疗胃胃肠间质瘤的疗效对比研究

Comparative study of laparoscopic and open surgery for gastric gastrointestinal stromal tumors

目的比较原发局限性胃胃肠间质瘤（GIST）行腹腔镜手术与丌腹手术的疗效，探讨腹腔镜技术应用于胃GIST手术中的可行性。方法回顾性分析2008年6月至2013年12月间在复旦大学附属中山医院接受手术治疗的167例原发局限性胃GIST患者的临床病理资料，其中55例施行腹腔镜手术（腹腔镜组），112例接受开腹手术（开腹组）；比较不同肿瘤大小及不同部位胃GIST行腹腔镜手术和开腹手术的疗效。结果腹腔镜组55例患者无一例中转开腹。对于直径小于5cm或位丁胃前壁、大弯侧和小弯侧的胃GIST，两组手术时间相近（P〉0．05），而术中出血量、术后住院时间或术后排气时间腹腔镜组明显优于开腹组（P〈0．05）；对于位于胃后壁的GIST，两组手术时间、术中出血量、术后排气时间和住院时间差异均无统计学意义（P〉0．05）；对于直径大于或等于5cm的胃GIST，腹腔镜组手术时间较开腹组有所延长（P〈=0．05），但术中出血量、术后住院时问和术后排气时问两组差异无统计学意义（P〉0．05）。腹腔镜组和开腹组术后出现并发症分别为2例（3．6％，均为胃瘫）和5例（4．5％。2例胃瘫、2例肺部感染和1例切口愈合不佳），差异无统计学意义（P〉0．05）：均对症保守治疗痊愈。术后腹腔镜组随访7～64（中位数25）月，未发现复发转移者，开腹组随访7～84（中位数47）月，有3例（2．7％）发生肝脏转移，两组患者无复发生存期比较，差异无统计学意义（P〉0．05）。结论腹腔镜手术治疗胃GIST安全有效，特别对于直径小于5cm或位于胃前壁及大、小弯侧的GIST，其短期疗效优于开腹手术．

Objective To investigate the feasibility and short-term efficacy of laparoscopic resection of primary localized gastric gastrointestinal stromal tumors （GIST） by comparing with open surgety. Methods Clinicopathologieal data of 167 gastric GIST patients undergoing operation in Zhongshan Hospital from June 2008 to December 2013 were retrospectively analyzed, among whom 55 received laparoseopie surgery and 112 underwent open surgery for primary local gastric GIST. Efficacy of different size and different location of GIST was compared between laparoseopic and open groups. Results There was no conversion to open surgery in laparoscopy group. Compared with open surgery, laparoscopic resection for gastric GIST smaller than 5 cm or located at anterior wall, greater curvature, lesser curvature, was associated with similar operation time（P〉0.05）, but less blood loss, shorter post- hospital stay or flatus time （all P〈0.05 ）. The operative outcomes were similar between laparoseopic and open resection for gastric GIST bigger than or equal to 5 cm or located at posterior wall （all P〉0.05）,except the longer operation time in laparoscopy group （P〈0.05）. The incidence of postoperative complication did not differ between two groups. Laparoscopic group had 2 patients with gastroparesis and open group had 2 gastroparesis, 2 pulmonary infection, and 1 poor wound healing （all P〉0.05）, which all recovered after conservative treatment. During 7 to 84 months （median 55） of follow-up, no recurrence or hepatic metastasis was found in laparoscopy group, and 3 hepatic metastases in open group. There was no significant difference of recurrence-free survival between two groups （P〉0.05）. Conclusion Laparoscopic resection for gastric GIST is safe and effective in selected patients, especially for those with tumors smaller than 5 cm, or located at anterior wall, greater curvature, lesser curvature, whose short-term outcomes are better than open resection.