内镜下切除与腹腔镜手术切除治疗胃间质瘤适应证及预后对比分析

Comparative analysis of indications and prognosis of endoscopic resection and laparoscopic surgery for gastric stromal tumors

目的 探讨并比较内镜下切除和腹腔镜手术切除治疗胃间质瘤的适应证及其预后影响。方法 回顾性选取2021年1月至2022年6月福建医科大学附属协和医院109例胃间质瘤患者,按照手术方法不同将其分为内镜切除组(n=54)和腹腔镜手术组(n=55),比较两组患者的手术指标、术后并发症发生情况、术后危险程度分级和复发转移情况。结果 内镜切除组患者的手术时间、术中出血量和术后肛门排气时间均明显低于腹腔镜手术组,差异有统计学意义(P<0.05);两组患者的术后住院时间比较,差异无统计学意义(P>0.05);内镜切除组患者术后并发症的总发生率为3.70%,明显低于腹腔镜手术组的16.36%,差异有统计学意义(P<0.05);内镜切除组术后患者危险分级为中危2例、低危25例、极低危27例,与腹腔镜手术组的高危3例、中危21例、低危23例、极低危8例比较,差异有统计学意义(P<0.05);内镜切除组患者术后6个月内的复发率为1.85%(1/54),无转移病例,腹腔镜手术组患者的复发率为5.45%(3/55),转移率为1.82%(1/55),两组比较差异无统计学意义(P>0.05)。结论 内镜切除术治疗胃间质瘤患者可有效改善手术相关指标,降低并发症发生率和危险程度,且复发、转移情况与腹腔镜手术相比无明显差异。

Objective To explore and compare the indications and prognostic implications of endoscopic resection and laparoscopic surgery for gastric stromal tumors.Methods A total of 109 patients with gastric stromal tumors admittedto Fujian Medical University Union Hospital from January 2021 to June 2022 were retrospectively selected and divided into the endoscopic resection group(n=54)and the laparoscopic surgery group(n=55)according to the different surgical methods.The surgical indicators,postoperative complications,postoperative risk classification and recurrence and metastasis were compared between the two groups.Results The operation time,intraoperative bleeding volume and time to postoperative anal exhaust of patients in the endoscopic resection group were significantly lower than those of patients in the laparoscopic surgery group,with statistically significant differences(P<0.05).There was no significant difference in the postoperative hospital stay between the two groups(P>0.05).The total incidence of postoperative complications in the endoscopic resection group(3.70%)was significantly lower than that in the laparoscopic surgery group(16.36%),with statistically significant difference(P<0.05).Compared with the high risk(n=3),medium risk(n=21),low risk(n=23)and extremely low risk(n=8)cases in the laparoscopic surgery group,the risk classifications of patients after operation in the endoscopic resection group were medium r isk(n=2),low risk(n=25)and extremely low risk(n=27),with statistically significant differences(P<0.05).The recurrence rate and metastasis rate of patients within six months after surgery in the endoscopic resection group(1.85%[1/54];0%[0/54])were lower than those in the laparoscopic surgery group(5.45%[3/55];1.82%[1/55]),with no statistically significant differences(P>0.05).Conclusion Endoscopic resection in the treatment of patients with gastric stromal tumors can effectively improve the indicators related to the operation and reduce the incidence and risk of complications.Moreover,the recurrence and metastasis are not significantly d ifferent from those of laparoscopic surgery.