内镜黏膜下剥离术与腹腔镜手术治疗直径≤5 cm胃间质瘤的疗效比较及对术后应激反应和胃肠激素的影响

Comparison the Efficacy of Endoscopic Submucosal Dissection and Laparoscopic Surgery in the Treatment of Gastric Stromal Tumors with Diameter ≤5 cm and its Effects on Postoperative Stress Response and Gastrointestinal Hormones

目的:对比内镜黏膜下剥离术(ESD)与腹腔镜手术(LAP)治疗直径≤5 cm胃间质瘤(GIST)的疗效及对术后应激反应和胃肠激素的影响。方法:回顾性分析2015年1月至2018年3月期间临汾市人民医院收治的170例直径≤5 cm GIST患者的临床资料。本研究按照手术方式的不同,将行LAP的患者83例纳为A组,将行ESD的患者87例纳为B组。对比两组疗效、围术期指标、术后应激反应和胃肠激素水平、并发症发生率。结果:与A组相比,B组住院总费用、术中出血量更少,术后首次进食流质时间、术后住院时间、术后排气时间、手术时间更短(P<0.05)。两组肿瘤完整切除率对比未见明显差异(P>0.05)。两组术后3 d血清肾上腺素(E)、去甲肾上腺素(NE)水平均升高,但B组低于A组(P<0.05)。两组术后3 d血清胃泌素(GAS)、胃动素(MTL)水平均下降,但B组高于A组(P<0.05)。两组并发症发生率对比,组间无统计学差异(P>0.05)。结论:ESD、LAP治疗直径≤5 cm GIST,疗效相当,其中ESD相对而言手术创伤更小、术后恢复更快,可能与减轻应激反应及减轻对胃肠激素的影响有关。

Objective: To compare the efficacy of endoscopic submucosal dissection(ESD) and laparoscopic surgery(LAP) in the treatment of gastric stromal tumors(GIST) with diameter ≤5 cm and the effects on postoperative stress response and gastrointestinal hormones. Methods: The clinical data of 170 patients with GIST with diameter ≤5 cm who were treated in Linfen People’s Hospital from January 2015 to March 2018 were analyzed retrospectively. According to different surgical methods, 83 patients undergoing LAP were included in group A, and 87 patients undergoing ESD were included in group B. The efficacy, perioperative indexes, postoperative stress response, gastrointestinal hormones levels and the incidence rate of complications were compared between the two groups. Results: Compared with group A, group B had less total hospitalization cost, less intraoperative bleeding, shorter first postoperative fluid intake time, postoperative hospitalization time, postoperative exhaust time and operation time(P<0.05). There was no significant difference in the complete tumor resection rate between the two groups(P>0.05). The levels of serum epinephrine(E) and norepinephrine(NE) at 3d after operation in two groups increased, but group B was lower than group A(P<0.05). The levels of serum gastrin(GAS) and motilin(MTL) at 3 d after operation in two groups decreased, but group B was higher than group A(P<0.05). There was no significant difference in the incidence rate of complications between the two groups(P>0.05). Conclusion: ESD and LAP are equally effective in treating GIST with diameter ≤5 cm. ESD has relatively less surgical trauma and faster postoperative recovery, which may be related to reducing stress response and reducing the impact on gastrointestinal hormones.