单中心腹腔镜与开腹手术切除胃间质瘤的临床疗效对比

Clinical controlled study of laparoscopic and open resection for gastrointestinal stromal tumors of stomach:a single center experience

目的比较分析腹腔镜手术和开腹手术切除胃间质瘤的临床疗效,讨论腹腔镜切除胃间质瘤的适用范围。方法回顾分析2008年7月至2014年4月第二军医大学长海医院胃肠外科手术切除并经术后病理证实为胃间质瘤的174例患者资料,其中腹腔镜组98例,开腹组76例,根据肿瘤大小(最长径)分为<5cm(113例,其中腹腔镜组78例、开腹组35例)和≥5cm且≤10cm(61例,其中腹腔镜组20例、开腹组41例)两个亚组,对性别、年龄、肿瘤大小、危险分级、核分裂象数、手术方式、手术时间、术中出血量、术后住院日、术后进食时间、无肿瘤生存时间等数据进行比较分析。结果肿瘤大小<5cm和≥5且≤10cm两亚组中,腹腔镜组与开腹组患者性别、年龄、肿瘤大小、危险分级、核分裂象数、手术方式差异均无统计学意义。在肿瘤大小<5cm亚组中,腹腔镜组与开腹组手术时间相当,差异无统计学意义,但术中出血量、术后住院日、术后进食时间腹腔镜组小于开腹组且差异有统计学意义(P<0.05);在肿瘤大小≥5cm且≤10cm亚组中,腹腔镜组与开腹组手术时间、术后住院日差异无统计学意义,但术中出血量、术后进食时间腹腔镜组小于开腹组且差异有统计学意义(P<0.05)。在肿瘤大小<5cm和≥5cm且≤10cm两亚组中,腹腔镜组与开腹组无瘤生存率差异均无统计学意义。结论对于胃间质瘤,当肿瘤大小<5cm时,腹腔镜是安全可靠的手术方案;当肿瘤大小≥5cm且≤10cm时,在做好术前评估及病例选择的前提下,腹腔镜手术是安全可行的。

Objective To compare the clinical efficacies between open resection and laparoscopic resection for gastrointestinal stromal tumors（GISTs）of stomach,and to discuss the indications of laparoscopic resection for GISTs.Methods A retrospective analysis was conducted in 174 patients with GISTs undergoing either open（open resection group [ORG],n=76）or laparoscopic resection（laparoscopic resection group[LRG],n=98）from July 2008 to April 2014 at Changhai Hospital.The patients,according to tumor size（max diameter）,were divided into two subgroups：〈5cm（113cases：35cases for ORG and 78 cases for LRG）,≥5cm and ≤10cm（61cases：41cases for ORG and 20 cases for LRG）.The data for analysis included gender,age,tumor size,risk grading,mitotic rate,surgical type,operative time,intraoperation blood loss,postoperative hospital stay,postoperative feeding time,and 5-year tumor-free survival time,etc.Results The gender,age,tumor size,risk grading,mitotic rate and surgical type of patients had no significant differences between the laparoscopic and open resection groups for the two tumor size groups.When the tumor size〈5cm,the operation time was similar for the two surgical approaches,but the blood loss,postoperative hospital stay and postoperative feeding time were significantly reduced in LRG compared with ORG（P〈0.01）.When the tumor size≥5cm and≤10cm,the operation time and postoperative hospital stay were similar between ORG and LRG,but the blood loss and postoperative feeding time of LRG were significantly less than those of ORG（P〈0.05）.The 5-year tumor-free survival time was not significantly different between LRG and ORG for the two tumor size groups.Conclusion When the tumor size is〈5cm,laparoscopic resection is more safe and reliable than open resection for the gastrointestinal stromal tumor of stomach;when the tumor size is≥5cm and≤10cm,laparoscopic resection is safe and feasible after appropriate preoperative evaluation and patient selection.