内镜全层切除术与外科手术切除胃巨大间质瘤的对照性分析(含视频)

Comparative analysis of endoscopic full-thickness resection and surgical resection of large gastric stromal tumors(with video)

目的评价内镜全层切除术治疗长径5~7 cm胃巨大间质瘤的安全性和有效性。方法回顾性分析2017年1月—2018年10月,于郑州大学第一附属医院接受内镜全层切除术或外科手术(包括腹腔镜及开腹手术)治疗,长径5~7 cm且经术后病理确诊为胃间质瘤的36例病例,按照手术方式分为内镜组9例和外科组27例,对比分析2组围术期指标和并发症总体发生率。结果围术期指标方面,内镜组中位手术时间明显长于外科组(4.0 h比2.0 h,P<0.01),术后禁食时间明显短于外科组[(4.55±0.88)d比(6.22±2.24)d,t=-2.15,P=0.03],术后住院时间明显短于外科组[(6.88±1.26)d比(10.03±2.90)d,t=-3.13,P<0.01],术后第1天腹痛视觉模拟评分中位评分明显低于外科组(3分比6分,P<0.01),术后第3天腹痛视觉模拟评分中位评分亦明显低于外科组(1分比3分,P<0.01),住院费用明显少于外科组[(5.5±1.47)万元比(7.3±2.43)万元,t=-2.11,P=0.04]。总体并发症发生率方面,内镜组为11.1%(1/9),高于外科手术组的7.4%(2/27),但差异无统计学意义(P=1.00)。结论内镜全层切除术治疗长径5~7 cm胃巨大间质瘤是安全和有效的,且具有创伤小、术后恢复快、住院费用低等优势,但如何缩短手术时间是亟待解决的问题。

Objective To study the safety and effectiveness of endoscopic full-thickness resection(EFR)in the treatment of large gastric stromal tumors with diameter of 5-7 cm.MethodsData of 36 patients with large gastric stromal tumors(5-7 cm)who received EFR or surgery(including laparoscopic and open surgery)in the First Affiliated Hospital of Zhengzhou University and confirmed by postoperative histopathology from January 2017 to October 2018 were retrospectively analyzed.Patients were divided into endoscopic group(9 cases)and surgical group(27 cases)according to different resection methods.The perioperative indicators and the total incidence of complications in the two groups were compared.ResultsIn terms of perioperative indicators,the median operation time of the endoscopic group was significantly longer than that of the surgical group(4.0 hours VS 2.0 hours,P<0.01),and the postoperative fasting time(4.55±0.88 days VS 6.22±2.24 days,t=-2.15,P=0.03)and hospital stay(6.88±1.26 days VS 10.03±2.90 days,t=-3.13,P<0.01)were significantly shorter than those of the surgical group.The median visual analogue scores(VAS)of abdominal pain of the endoscopic group on the first postoperative day(3 VS 6,P<0.01)and the third postoperative day(1 VS 3,P<0.01)were significantly lower than those of the surgical group.The hospitalization cost was significantly less than that of the surgical group(55±14.7 thousand yuan VS 73±24.3 thousand yuan,t=-2.11,P=0.04).In term of the total incidence of complications,the endoscopic group was 11.1%(1/9),which was higher than that of the surgical group[7.4%(2/27)],but there was no statistically significant difference(P=1.00).ConclusionEFR is safe and effective in the treatment of large gastric stromal tumors(5-7 cm),and has the advantages of less invasiveness,rapid postoperative recovery,and lower hospitalization cost.But how to shorten the operation time is an urgent problem to be solved.