胃镜或胃镜联合腹腔镜微创手术治疗胃间质瘤

The clinical significance of gastric stromal tumor minimally invasive surgery

目的探讨胃镜或胃镜联合腹腔镜微创手术治疗胃间质瘤的临床意义。方法收集胃间质瘤手术患者80例，其中7例采用单纯胃镜切除，32例采用腹腔镜或胃镜联合腹腔镜手术治疗，41例为开腹手术切除，分析3种手术方式的疗效及临床手术相关指标的差异。结果（1）所有胃间质瘤患者经病理检查证实均达到完全（RO）切除，患者性别（P〉0．05）、年龄（P〉0．05）、肿瘤部位（P〉0．05）与肿瘤术后危险度分级差异无统计学意义；手术方式（r=0．311，P〈0．05）与肿瘤术后危险度分级差异有统计学意义（P〈0．05）；（2）微创手术组（胃镜组和腹腔镜或腹腔镜联合胃镜组）在手术时间[（57．14±27．21）、（100．31±38．56）比（126．95±45．39）min]、术中出血量[（34．29±16．18）、（56．00±23．14）比（102．07±44．37）ml]、弓l流液量[0、（62．13±32．80）比（78．59±38．71）ml]、术后排气时间[（2．57±1．40）、（2．81±1．28）比（5．41±1．66）d]、术后住院时间[（5．57±1．27）、（7．09±2．68）比（12．54±3．56）d]均小于开腹组，差异有统计学意义（P〈0．05）；（3）肿瘤直径≤2cm时，胃镜组在手术时间[（57．14±27．21）比（106．25±42．64）min]、术中失血量[（34．29±16．18）比（57．65±22．91）ml]、术后住院时间[（5．57±1．27）比（7．35±3．05）d]上均小于腹腔镜或腹腔镜联合胃镜组，差异有统计学意义（P〈0．05），术后排气时间[（2．40±0．94）比（2．57±1．40）d]上腹腔镜或腹腔镜联合胃镜组小于胃镜组差异有统计学意义（P〈0．05）；肿瘤直径〉2em且≤5cm时，腹腔镜或腹腔镜联合胃镜组在手术时间[（90．42±29．65）比（115．87±40．67）min]、术中失血量[（53．25±24．28）比（92．61±35．06）ml]、引流液量[（53．08±33．36）比（87．13±37．95）ml]、术后排气时间[（3．50±1．51）比（5．48±1．93）d]、术后住院时间[（6．67±1．97）比（12．09±4．08）d]上均显著小于开腹组，差异有统计学意义（P〈0．05）。结论胃间质瘤患者肿瘤直径≤2em时，单纯胃镜手术治疗安全有效；而肿瘤直径〉5cm时，仍建议开腹手术；2cm〈肿瘤直径≤5cm时，腹腔镜或腹腔镜联合胃镜手术疗效等同于开腹手术且具有手术时间短、术后恢复快、住院时间短等优势。

Objective To investigate the clinical significance of the treatment of gastric stromal tumor by using gastroscope or gastroscope combined with laparoscopy minimally invasive surgery. Methods Eighty cases undergoing gastric stromal tumor surgery were collected in Jiangnan University Affiliated Hos- pital between December 2008 and January 2015, including 7 cases receiving pure gastroscope resection, 32 cases given ]aparoscopy or ]aparoscopy combined with gastroscopy, 41 cases subject to traditional open sur- gery. The curative effect of three surgical procedures and the difference in clinical parameters related to the procedures were retrospectively analyzed. Results （ 1 ） All patients with gastric stromal tumors achieved RO resection confirmed pathologically. Postoperative risk grade was not correlated with gender （ P 〉0. 05 ）,age （ P 〉 0. 05 ） and tumor location （ P 〉 0. 05 ）, but with surgical procedures （ P 〈 0. 05, r = 0. 311 ） ; （ 2 ） In the minimally invasive surgery groups, operation time was shorter [ （57.14 ± 27.21 ） and （ 100. 31 ± 38.56） vs. （ 126. 95 ±45.39） mini, intraoperative blood loss was less [ （34. 29 ± 16. 18） and （56. 00 ± 23.14） vs. （102.07 ±44.37） mini, drainage amount [0, and （62.13 ±32.80） vs. （78.59 ± 38.71） ml], postoperative flatus time was shorter [ （2. 57 ± 1.40） and （ 2. 81 ± 1.28 ） vs. （5.41 ± 1.66） h ], and post - hospital stay was shorter [ （5. 57 ± 1.27 ） and （7.09 ± 2.68） vs. （ 12. 54 ± 3.56） days ] than in open surgery group with the difference being statistically significant （ all P 〈 0. 05 ） ; （ 3 ） In gastroscope group, operative time was shorter [ （57.14 ± 27. 21 ） vs. （ 106. 25 ±42. 64） mini , intraoper- ative blood loss was less [ （34. 29 ± 16. 18） vs. （57.65 ±22. 91 ） ml] , and post - hospital stay was shor- ter [ （5.57 ± 1.27） vs. （7.35 ±3.05） days] than in laparoscopic or laparoscopy combined with gastros- copy group when the tumor diameter was ±〈2 cm with the difference being statistically significant （ all P 〈0. 05 ）. In laparoscopy or laparoscopy combined with gastroscopy group, flatus time was shorter [ （2.40 ±0. 94） vs. （2.57 ± 1.40） h ] than in gastroscope group （ P 〈 0. 05 ）. When the tumor diameter 〉 2 cm and ±〈5 cm, in laparoscopy group or laparoscopy combined with gastroscopy group, the operative time was shorter [ （90. 42 ±29. 65） vs. （ 115.87 ±40.67） mini, intraoperative blood loss was less [ （53.25 ± 24. 28） vs. （92.61 ±35.06） ml], drainage amount was less [（53.08 ± 33.36） vs. （87.13 ± 37.95 ） ml ], flatus time was shorter [ （3.50 ± 1.51 ） vs. （5.48 ± 1.93 ） h ], and post - hospital stay was shorter[ （6. 67 ± 1.97） vs. （ 12. 09 ± 4. 08） days] in open surgery group （ all P 〈 0. 05 ）. Conclusion Gastroscopic resection for gastric gastric stromal tumors is safe and effective when the tumor diameter is 2 cm. The open operation is recommended when the tumor diameter 〉 5 cm. For those with tumors 〉 2 cm and ≤5 cm, the curative effect of laparoscopy or laparoscopy combined with gastroscopy is equal to open operation, it has shorter operation time, quicker recovery time, and shorter hospital stay.