不同手术方式治疗5~10 cm胃间质瘤的效果比较

Effect of different surgical methods in the treatment of 5-10 cm gastric stromal tumor

目的比较腹腔镜、内镜及双镜联合的手术方式治疗5~10 cm胃间质瘤(GST)的效果。方法回顾性分析2005年2月至2020年2月安阳市中医院收治完成手术治疗及随访116例5~10 cm GST患者资料,根据不同手术方式分为三组。A组38例行内镜黏膜下剥离术(ESD),B组39例行腹腔镜下手术,C组39例行腹腔镜内镜联合切除术(LECS);比较三组患者手术及恢复指标;比较三组术前、术后3个月胃肠功能,胃肠功能采用胃肠道生活质量指数(GIQLI)评估;记录术后并发症。结果术后3个月,三组GIQLI评分均较术前升高,且C组高于A、B组(P<0.05),但A、B组组间比较差异未见统计学意义(P>0.05);三组手术时间比较差异未见统计学意义(P>0.05);与A、B组比较,C组术中出血量少,术后首次进食时间、肛门首次排气时间、住院时间短且并发症发生率低(P<0.05),但A、B组组间上述指标比较差异未见统计学意义(P>0.05)。结论与ESD、腹腔镜手术单独应用比较,LECS治疗5~10 cm GST患者,可减少术中出血量,促进胃肠恢复,并发症少,有较高的应用价值。

Objective To compare the effects of laparoscopy,endoscopy and double endoscopy combined surgical methods in the treatment of 5-10 cm gastric stromal tumor(GST).Methods The data of 116 patients with 5-10 cm GST who were treated and completed surgical treatment in Anyang Traditional Chinese Medicine Hospital from February 2005 to February 2020 were retrospectively analyzed,according to different surgical methods,they were divided into 3 groups.Group A(38 cases)was treated with endoscopic submucosal dissection(ESD),group B(39 cases)was treated with laparoscopic surgery,and group C(39 cases)was treated with laparoscopic endoscopic resection(LECs);the operation and recovery indexes of the three groups were compared;the gastrointestinal function was compared between the three groups before and 3 months after operation,the gastrointestinal function was assessed by gastrointestinal quality of life index(GIQLI);the postoperative complications of the three groups were recorded and compared.Results Three months after operation,GIQLI scores of three groups were higher than those before operation,and those of group C were higher than those of group A and group B(P<0.05),but there were no significant differences between group A and group B(P>0.05);the operation time of the three groups was longer than that of the control group,but the difference was not statistically significant(P>0.05);compared with group A and group B,group C had less intraoperative blood loss,shorter postoperative first eating time,anal exhaust time,hospitalization time,and lower incidence of complications(P<0.05),but there were no significant differences in the above indexes between group A and group B(P>0.05).Conclusions Compared with ESD and laparoscopic surgery alone,LECS can reduce intraoperative blood loss in the treatment of patients with 5-10 cm GST,it is more conducive to promote the recovery of gastrointestinal function after operation,with less complications and higher application value.