不行标记和黏膜下注射的内镜黏膜下肿瘤挖除术治疗胃小胃肠间质瘤的疗效和安全性

The efficacy and safety of endoscopic submucosal tumor resection without labeling and submucosal injection for the treatment of gastric small gastrointestinal stromal tumors

目的探讨不行标记和黏膜下注射的内镜黏膜下肿瘤挖除术(NMSI-ESE)治疗胃小胃肠间质瘤的疗效和安全性。方法回顾性分析2019年1月至2023年12月在树兰(杭州)医院胃肠外科诊断为胃小胃肠间质瘤的49例患者临床资料,其中23例行NMSI-ESE,26例行传统内镜黏膜下肿瘤挖除术(ESE)。比较两组患者的临床病理特征、手术时间、瘤体挖除时间、金属夹使用数量、手术费用、术后住院时间和并发症发生情况。结果与ESE组比较,NMSI-ESE组的手术时间更短[38.95(26.50,53.25)min vs 47.30(38.50,52.25)min,Z=-2.60,P=0.011]、瘤体挖除时间更短[17.27(8.75,24.50)min vs 27.08(18.75,35.00)min,Z=-4.32,P<0.001]、手术费用更少[3308(3190,3450)元vs 4107(3972,4232)元,Z=-20.95,P<0.001]、金属夹使用数量更少[(3.86±0.91)个vs(5.04±1.22)个,t=-4.00,P<0.001]及术后住院时间更短[3.1(2.0,4.0)d vs 3.5(3.0,4.0)d,Z=-2.20,P=0.031],而在术中穿孔、R0切除以及术后并发症方面差异均无统计学意义(均P>0.05)。随访期间内,两组患者均无肿瘤复发或转移。结论NMSI-ESE治疗胃小胃肠间质瘤安全、有效,且较传统ESE可缩短手术时间和住院时间,减少医疗费用。

ObjectiveTo investigate the efficacy and safety of endoscopic submucosal tumor resection without labeling and submucosal injection(NMSI-ESE)in the treatment of gastric small gastrointestinal stromal tumors.MethodsA retrospective analysis was conducted on the clinical data of 49 patients diagnosed with gastric small gastrointestinal stromal tumors in the Department of Gastrointestinal Surgery at the Shulan(Hangzhou)Hospital from January 2019 to December 2023.Among them,23 cases underwent NMSI-ESE and 26 cases underwent traditional endoscopic submucosal tumor resection(ESE).We compared the clinical and pathological characteristics,surgical time,tumor removal time,number of metal clips used,surgical costs,postoperative hospitalization time,and incidence of complications between two groups of patients.ResultsCompared with the ESE group,the NMSI-ESE group had shorter surgical time[38.95(26.50,53.25)min vs 47.30(38.50,52.25)min,Z=-2.60,P=0.011],shorter tumor removal time[17.27(8.75,24.50)min vs 27.08(18.75,35.00)min,Z=-4.32,P<0.001],and lower surgical costs[3308(3.190,3450)yuan vs 4107(3972,4232)yuan,Z=-20.95,P<0.001],fewer metal clips used[(3.86±0.91)vs(5.04±1.22),t=-4.00,P<0.001],and shorter postoperative hospitalization time[3.1(2.0,4.0)d vs 3.5(3.0,4.0)d,Z=-2.20,P=0.031],There was no statistically significant difference in R0 resection rate and postoperative complications(all P>0.05).During the follow-up period,both groups of patients had no tumor recurrence or metastasis.ConclusionsNMSI-ESE is safe and effective in treating small gastrointestinal stromal tumors,and can shorten surgical and hospitalization time,as well as reduce medical costs compared to traditional ESE.