内镜下黏膜剥离术与腹腔镜术治疗胃间质瘤的临床对比研究

Comparison of endoscopic submucosal dissection and laparoscopic surgery for treating gastric gastrointestinal stromal tumors

目的探讨内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)和腹腔镜术(laparoscopic resection,LAP)治疗直径≤5 cm胃间质瘤(gastrointestinal stromal tumors,GISTs)的临床疗效和安全性分析。方法回顾性分析川北医学院附属医院2017年至2019年因胃GISTs(直径≤5 cm)而行ESD或LAP治疗的84例患者的临床资料。按手术方法分为ESD组35例,LAP组49例,分析两组患者的流行病学资料、治疗效果、总体并发症和随访结果。结果患者临床特征良好平衡,ESD组平均肿瘤直径小于LAP组(P=0.000);ESD组腔内生长肿瘤比例高,LAP组腔外生长肿瘤比例高(P=0.000);两组在肿瘤完整切除率(P=1.000)、总体并发症(P=0.354)等方面无统计学意义。与LAP相比,ESD组平均手术时间短(P=0.011)、平均术中出血量少(P=0.000)、术后腹痛时间短(P=0.000)、术后禁食时间短(P=0.023)、术后住院时间短(P=0.000)、住院总费用(P=0.000)及手术费用(P=0.000)均较低,差异均有统计学意义。两组在随访期间均未发现复发和转移病例。结论采用ESD与LAP治疗直径≤5 cm的胃GISTs是安全、有效的,两者疗效相似,但ESD创伤更小、术后恢复更快、住院费用更低。

Objective This study aimed to explore the clinical efficacy and safety of endoscopic mucosal dissection(ESD)and laparoscopic surgery(LAP)Zfor treating gastric gastrointestinal stromal tumors(GISTs)≤5 cm.Methods We retrospectively collected the clinical data of the 84 patients with gastrointestinal stromal tumors smaller than 5 cm who underwent endoscopic submucosal dissection or laparoscopic surgery at Affiliated Hospital of North Sichuan Medical College between 2017 and 2019.The patients were divided into ESD group and lap group according to the operation mode,35 patients underwent ESD and the other 49 received LAP.Epidemiological data(age,gender),treatment effect,overall complications and follow-up results were compared between ESD and LAP.Results The patient’s clinical characteristics are well balanced.Compared with patients in the ESD and LAP group,patients in the ESD group had a smaller tumor size(P=0.000)and a higher percentage of intragastric growth pattern(P=0.000).There was no signifificant difference between the two groups in complete tumor resection rate and adverse events(P>0.05).However,patients in the ESD groups had a shorter operating time,a less intraoperative bleeding,a shorter postoperative abdominal pain,a shorter anal exhaust time,a shorter oral intake,a shorter postoperative hospital stay,and a fewer cost(P<0.001).During the follow-up period,no recurrence or metastasis was found in the two groups.Conclusion It is safe and feasible for gastric GISTs≤5 cm by ESD and LAP.The curative effect of the two groups is similar.there is a significant advantage in ESD group for a less trauma,a faster recovery,a shorter postoperative hospital stay,and a fewer cost.