内镜切除与腹腔镜手术治疗胃间质瘤临床对比分析

Comparison of endoscopic resection and laparoscopic surgery in the treatment of gastric stromal tumors

目的:比较内镜切除与腹腔镜手术治疗直径为2~5cm胃间质瘤的临床对比分析,探讨消化内镜治疗较大胃间质瘤的临床应用价值。方法:收集2013年6月至2018年6月我院病理诊断为胃间质瘤的78例患者临床资料,其中内镜组45例,腹腔镜组33例,比较二者的一般资料、围手术期及随访等情况。结果:两组在年龄、性别、肿瘤生长部位、肿瘤危险程度分级上差异无统计学意义(P>0.05);内镜组肿瘤直径[(3.13±0.83)cm]较腹腔镜组[(3.67±1.03)cm]小,差异有统计学意义(P<0.05)。两组在完整切除率上差异无统计学意义;内镜组手术时间、术后排气时间、术后住院时间、住院总费用均小于腹腔镜组,差异有统计学意义(P<0.05);内镜组并发症发生率为17.8%,较腹腔镜组(6.1%)高,差异有统计学意义(P<0.05)。内镜组术后随访(22.4±15.4)个月,腹腔镜组术后随访(24.7±17.5)个月,差异无统计学意义(P>0.05)。随访期间,内镜组均未发生复发、转移和死亡,腹腔镜组1例术后14个月复发,两组在复发、转移及死亡率上差异无统计学意义(P>0.05)。结论:内镜下治疗2~5cm直径的胃间质瘤创伤小、恢复快、疗效好,预后和腹腔镜无差异,但是内镜组手术主动穿孔与被动穿孔发生率较高,但均能成功缝合,不影响预后及经济性,内镜下治疗较大直径的胃间质瘤有望成为开腹手术及腹腔镜手术之外的方式之一,更广泛应用于临床。

Objective:To compare and analyze the clinical data of endoscopic resection and laparoscopic surgery in the treatment of gastric stromal tumors with a diameter of 2~5 cm,to explore the clinical application value of endoscopic treatment for the larger gastric stromal tumors.Methods:Clinical data of 78 patients with pathological diagnosis of gastric stromal tumor from June 2013 to June 2018 were retrospectively collected,including 45 patients undergoing endoscopic treatment(endoscopic group)and 33 patients treated with laparoscopic surgery(laparoscopic group).The information,perioperative data and follow-up were compared.Results:There was no significant difference between the two groups in age,gender,tumor growth location and tumor risk grade(P>0.05).The diameter of endoscopic group[(3.13±0.83)cm]was smaller than that of laparoscopic group[(3.67±1.03)cm],and the difference was statistically significant(P<0.05).There was no significant difference in complete resection rate.The operative time,postoperative exhaust time,postoperative hospitalization time,total cost of hospitalization were lower in the endoscopic group than in the laparoscopic group,and the difference was statistically significant(P<0.05).The incidence of complications in endoscopic group(17.8%)was significantly higher than that in laparoscopic group(6.1%)(P<0.05).There was no significant difference between the average follow-up time between in the endoscopic group[(22.4±15.4)months]and in the laparoscopic group[(24.7±17.5)months](P>0.05).During the follow-up period,no recurrence,metastasis and death occurred in endoscopic group,and 1 case in laparoscopic group recurred after operation for 14 months.There was no significant difference in recurrence,metastasis and mortality between the two groups(P>0.05).Conclusion:Endoscopic treatment of 2~5 cm diameter gastric stromal tumor has little trauma,quick recovery,good curative effect,and no difference in prognosis with laparoscopy surgery.However,the incidence of active and passive perforation in endoscopic group is higher,but both of them can be sutured successfully without affecting prognosis and economy.Endoscopic treatment may be one of the surgical methods to treat large diameter gastric stromal tumors other than laparotomy and laparoscopy,and it will be widely used in clinical practice.