腹腔镜与开腹胃楔形切除术治疗胃间质瘤的对照研究

Laparoscopic versus open wedge resection of gastric gastrointestinal stromal tumors： a non-randomized case-matched study

目的探讨腹腔镜与开腹胃楔形切除术治疗胃间质瘤的适应证及安全性。方法2010年至2014年间手术治疗的胃间质瘤患者按照肿瘤直径进行1：1配对，分为开腹组和腹腔镜组，分析两组患者的临床病理资料、围手术期相关因素、术后营养状况及短期预后。结果共入组胃问质瘤患着100例，年龄为（58．99±10．41）岁、其中开腹组50例．腹腔镜组50例，开腹组和腹腔镜组患者的年龄分别为（61．58±10．43）岁和（56．40±9．82）岁，差异有统计学意义（P=0．012）。开腹组和腹腔镜组患者的肿瘤多位于胃体，分刚占52．O％（26／50）和56．O％（28／50）。两组患者的手术时间差异无统计学意义（P=0．075），开腹组和腹腔镜组的术中出血量分别为（137．60±140．69）ml和（48．60±48．89）ml，住院时间分圳为（17．22±7．11）d和（12．14±4．32）d，胃管留置时间分别为（6．28±3．73）d和（3．76±1．73）d，腹腔镜组明显优于开腹组，差异均有统计学意义（均P〈O．001）。开腹组和腹腔镜组患者的术后前白蛋白水平分别为（0．11±0．05）g／L和（0．07±0．04）g/L，转铁蛋门水平分圳为（0．64±0．30）g／L。和（0．51±0．29）g/L,差异均有统计 学意义（均P〈O．05）。腹腔镜组患者的术后并发症发生率（2．0％，1／50）显著低于开外腹组（14．0％，7／50），差异有统计学意义（P=O．027）。结论腹腔镜胃楔形切除术治疗胃间质具有良好的安全性，患扦恢复迅速，营养状况较好．

Objective To investigate the safety and feasibility of laparoseopic wedge resection for gastrit gaslroiniestinal stromal tumors （GIST）. Methods One hundred GIST patients treated in our departulent belween 2010 and 2014 were retrospectively enrolled, and their clinieopathologieal data were reviewed. Fifty patients underwent laparoseopic wedge resection, and open surgery cases were 1 ： 1 matched by tumor diameter. The clinieopathological characteristics, perioperative related factors, postoperative nutritional status and short-term outcome were compared between the two groups. Results Among the .linicopathologieal characteristics, only the age was of statistical significance （61.58± 10.43 vs. 56.40±9.82, P= 0.012） . Over fifty percent of the tumors occurred in the gastric body. Although the short-term survival did not show statistical significance, the laparoscopic group showed predominant advantages in estimated blood h〉ss I （48.60±48.89） ml vs. （137.60±140.69） ml, P〈0.001], average hospital stay （12.14±4.32） d vs.（17.22±7.11） d, P〈0.001], oral intake time[ （3.76±1.73）d vs. （6.28±3.73）d, P〈0.01], decline of prealbnmin （0.07±0.04） g/L vs. （0.11±0.05 ） g/L, P〈0.001 ） 1, decline of transferrin I （0-51±0.29） g/L vs. （0.64±0.30）g/L, P=0.034]and complication （2.0% vs. 14.0%, P=0.027）. Conclusion Laparoseopic wedge resection is feasible and safe for GIST surgery, allows a rapid recovery and having a better nutritionalstatus in patients, and is a less invasive approach for patients.