腹腔镜联合胃镜手术治疗固有肌层来源的胃间质瘤的安全性及可行性

Safety and Feasibility of Laparoscopy Combined with Gastroscopy in Treatment of Gastric Stromal Tumors Originating from Muscularis Propria

目的探讨腹腔镜联合胃镜手术治疗固有肌层来源的胃间质瘤(GSTs)的安全性及可行性。方法回顾性分析2014年7月至2016年10月接收的固有肌层来源GSTs患者130例,根据其手术方式分为腹腔镜手术组(87例)和开腹手术组(43例),又根据具体手术方式分为楔形胃切除术组(腹腔镜组68例,开腹组20例)和近端/远端胃切除术组(腹腔镜组19例,开腹组23例),腹腔镜手术组根据需要实施腹腔镜联合胃镜手术治疗。采用SPSS 21.0软件进行处理,术中术后各项指标用(±s)描述,采用独立样本t检验,两组患者并发症发生率、术后复发或转移率等应用χ~2检验,P<0.05表示差异有统计学意义。结果两组患者肿瘤直径、核分裂数以及恶性潜能分级情况和术后严重并发症发生率、复发或转移率差异无统计学意义(P>0.05);腹腔镜手术组患者手术切口长度、术中出血量、术后肛门排气时间及术后住院时间少于开腹组,差异有统计学意义(P<0.05)。楔形胃切除术组中腹腔镜组患者手术时间短于开腹组(P<0.05),但在近端/远端胃切除术组中腹腔镜组手术时间和开腹组患者相比且差异无统计学意义(P>0.05)。结论固有肌层来源的胃间质瘤患者腹腔镜联合胃镜手术创伤小,术中出血量少且术后恢复快,手术安全可行,值得临床推广应用。

Objective To investigate the safety and feasibility of laparoscopic combined endoscopy in the treatment of gastric myogenic stromal tumors（ GSTs）. Methods 130 patients with GSTs originated from muscularis propria layer treated in our hospital from July 2014 to October 2016 were analyzed,and were divided into laparoscopic surgery group（87 cases） and open surgery group（43 cases） according to surgery methods,and were divided into wedge gastrectomy group（68 cases in laparoscopic group and 20 cases in laparotomy group） and proximal/distal gastrectomy group（19 cases in laparoscopic group and 23 cases in laparotomy group）. Laparoscopic surgery group was treated with laparoscopy combined with gastroscope if needed. SPSS 21. 0 software was used for data analysis. The intraoperative and postoperative data were described by（ ± s） and compared with independent sample t test. The incidence of complications,postoperative recurrence or metastasis were compared with χ~2 test,P〈 0. 05 meant the difference was statistically significant. Results There was no significant difference in tumor diameter,mitotic number,grade of malignant potential,serious postoperative complication rate,recurrence or metastasis between the two groups（ P〉 0. 05）. The length of incision, blood loss, postoperative anal exhaust time and postoperative hospital stay in the laparoscopic surgery group were significantly lower than those in the open group（ P〈 0. 05）. In the wedge gastrectomy group, the operation time of laparoscopic group was significantly shorter than that of laparotomy group（ P 〈0. 05）,but there was no significant difference in operation time between laparoscopic group and open laparotomy group with proximal and distal gastrectomy（P〉 0. 05）. Conclusion It has small trauma,less intraoperative blood loss and rapid postoperative recovery Laparoscopy combined with gastroscopy in Treatment of Gastric Stromal Tumors Originating from Muscularis Propria in patients with gastric stromal tumors originated from muscularis propria treated by laparoscopy combined with gastroscopy,with safe and feasible surgery. It is worthy of clinical application.