内镜黏膜下挖除术与全层切除术治疗腔内生长胃间质瘤的疗效及安全性比较

Comparison of the efficacy and safety of endoscopic submucosal excavation and full-thickness resection for intraluminal gastric stromal tumors

目的比较内镜黏膜下挖除术(endoscopic submucosal excavation,ESE)和内镜全层切除术(endoscopic full-thickness resection,EFR)治疗腔内生长胃间质瘤的疗效及安全性。方法回顾性分析2009年6月—2020年6月在南京鼓楼医院确诊为胃间质瘤的441例患者资料,其中241例行ESE(ESE组),200例行EFR(EFR组)。比较两组患者的基础数据(性别、年龄、体重指数),肿瘤大小,手术相关参数,并发症,住院时间,费用和随访情况。结果两组患者在性别、年龄、体重指数、肿瘤大小、美国国立卫生研究院危险度分级、完整切除率、整块切除率等方面差异均无统计学意义(P>0.05)。与EFR组比较,ESE组手术所需关闭胃壁缺损的钛夹数量更少[6.0(4.0,6.0)个比6.0(5.0,8.0)个,U=18424.0,P<0.001],术后首次流食时间[2.0(1.0,2.0)d比2.0(2.0,3.0)d,U=17420.0,P<0.001]与住院时间[6.0(5.0,8.0)d比7.0(6.0,9.0)d,U=18906.0,P<0.001]更短,总费用更低[1.89(1.64,2.14)万元比2.09(1.81,2.38)万元,U=17956.0,P<0.001],且并发症总发生率低于EFR组[5.8%(14/241)比11.5%(23/200),χ^(2)=4.605,P=0.032]。441例患者均接受随访,中位随访时间45.0个月,疾病复发率为0.45%(2/441),无疾病相关死亡病例。结论ESE和EFR治疗腔内生长胃间质瘤的疗效相当,但ESE并发症发生率较低,并可缩短住院时间,降低费用负担。

Objective To compare the efficacy and safety of endoscopic submucosal excavation(ESE)and endoscopic full-thickness resection(EFR)for intraluminal gastric stromal tumors.Methods Data of 441 patients diagnosed as having gastric stromal tumors in Nanjing Drum Tower Hospital from June 2009 to June 2020 were retrospectively analyzed.A total of 241 patients underwent ESE(ESE group)and 200 EFR(EFR group).Epidemiological data(gender,age and body mass index),tumor size,procedure related parameters,complications,hospital stay,cost and follow-up were compared between the two groups.Results There were no significant differences between the two groups in gender,age,body mass index,tumor size,National Institutes of Health risk grade,complete resection rate,or block resection rate(P>0.05).Compared with the EFR group,the ESE group required less titanium clips to close defects in the stomach wall[6.0(4.0,6.0)VS 6.0(5.0,8.0),U=18424.0.P<0.001],shorter time of first postoperative fluid intake[2.0(1.0,2.0)days VS 2.0(2.0,3.0)days,U=17420.0,P<0.001]and hospital stay[6.0(5.0,8.0)days VS 7.0(6.0,9.0)days,U=18906.0,P<0.001],and lower total cost[18.9(16.4,21.4)thousand yuan VS 20.9(18.1,23.8)thousand yuan,U=17956.0,P<0.001].Moreover,the total incidence of complications of the ESE group was lower than that of the EFR group[5.8%(14/241)VS 11.5%(23/200),χ^(2)=4.605,P=0.032].Patients were followed up with the median period of 45.0 months.The disease recurrence rate was 0.45%(2/441),and there were no disease-related deaths.Conclusion The efficacy is comparable between ESE and EFR for treating intraluminal gastric stromal tumors,but ESE shows a lower incidence of complications,and requires a shorter hospital stay and lower cost.