腹腔镜与开腹手术治疗大于5cm胃胃肠间质瘤的临床疗效对比研究

Comparative study of laparoscopic and open surgery for gastric gastrointestinal stromal tumors larger than 5cm

目的比较腹腔镜手术与开腹手术治疗肿瘤大于5cm的胃胃肠间质瘤(GIST)的临床疗效,探讨腹腔镜手术应用于大于5cm的胃GIST治疗的可行性。方法回顾性分析2014年5月~2018年5月浙江大学医学院附属第一医院胃肠外科收治的28例直径大于5cm的原发局限性胃GIST患者的临床资料,根据术式不同分为腹腔镜组(13例)和开腹组(15例)。比较两组患者术中术后的各项指标,分析大于5cm的胃GIST行腹腔镜手术和开放手术的疗效。结果腹腔镜组手术时间明显长于开腹组[(152.6±56.0)分vs (111.2±42.5)分,P=0.035],而术后胃管或引流管的拔除时间腹腔镜组明显短于开腹组(P <0.05),腹腔镜组术中出血量、肠道恢复时间和术后住院时间均优于开腹组,但差异无统计学意义(P> 0.05)。两组手术并发症及术后复发比较,差异无统计学意义(P> 0.05)。结论腹腔镜手术治疗大于5cm的胃GIST安全可行,值得临床推广。

Objective To investigate the efficacy of laparoscopic and open surgery for gastric gastrointestinal stromal tumors（GIST） larger than 5cm in the stomach, to investigate the feasibility of laparoscopic surgery for gastric GIST larger than 5cm. Methods Clinical data of 28 patients with primary localized gastric GIST, who received surgery in the First Affiliated Hospital of Zhejiang University, School of Medicine from May 2014 to May 2018 were retrospectively analyzed. Among them, 13 patients received laparoscopic surgery（laparoscopic group）, and 15 patients received open surgery（open group）. Related indicators of clinical efficacy were compared between the two groups. Results The operation time of laparoscopic group was significantly longer than that of the open group [（152.6 ± 56.0） min versus （111.2 ± 42.5） min, P=0.035], but the extraction time of gastric tube or drainage tube of laparoscopic group was shorter than that of the open group（both P 〈 0.05）. The intra-operative blood loss, the intestinal recovery time and the postoperative hospitalization time in the laparoscopic group were less than those in the open group, though differences were not significant（all P 〉 0.05）. The postoperative complications and recurrences were similar between the two groups（all P 〉 0.05）. Conclusion Laparoscopic resection for the treatment of gastric GIST larger than 5cm is safe and feasible in selected patients, which is worth of clinical promotion.