内镜下手术治疗2～5 cm胃间质瘤的效果

Effect of endoscopic surgery in patients with 2~5 cm gastric gastrointestinal stromal tumor

摘要:

目的 探讨2～5 cm胃间质瘤（gastric GIST）患者的内镜下手术效果。方法 选取2017年1月－2020年1月于该院接受治疗的gastric GIST患者412例，根据手术方法不同，分为内镜切除手术组（内镜组，196例）和腹腔镜切除手术组（腹腔镜组，216例）。观察两组患者围手术期指标、术后并发症发生情况、肿瘤位置、危险度分级和术后随访情况等。结果 内镜组和腹腔镜组性别、年龄、肿瘤位置、危险度分级、既往是否有手术史以及肿瘤起源层次比较，差异均无统计学意义（P > 0.05）；内镜组手术时间、禁食时间、留置胃管时间、术后住院时间和术后通便时间短于腹腔镜组，术中出血量少于腹腔镜组，术后并发症发生率为18.37%，低于腹腔镜组的27.78%，差异均有统计学意义（P < 0.05）。内镜组术后随访13～33个月，平均（23.04±10.38）个月，腹腔镜组术后随访13～35个月，平均（22.71±10.69）个月，内镜组术后复发4例，无转移发生，占比2.04%，腹腔镜组术后复发8例，转移8例，占比7.41%，内镜组手术破损瘤体4例（2.04%），腹腔镜组手术破损瘤体8例（3.70%），均无死亡发生，两组患者上述指标比较，差异无统计学意义（P > 0.05）。结论 对2～5 cm的gastric GIST患者采用内镜下手术治疗，能够减少术中出血量，促进术后恢复，降低术后并发症发生率，具有较好的安全性，值得临床推广。

Abstract:

Objective To investigation the effect of endoscopic surgery in patients with gastric gastrointestinal stromal tumor (gastric GIST) of 2~5 cm.Methods 412 patients with gastric GIST who were treated from January 2017 to January 2020 were selected and divided into the endoscopic resection group (endoscopy group, 196 cases) and the laparoscopic resection group (laparoscopy group, 216 cases) according to different surgical methods. The perioperative indexes, postoperative complications, tumor localization, risk classification and postoperative follow-up status of two groups were observed.Results The comparison of the basic data showed that there were no significant differences between the two groups in terms of gender ratio, age, tumor localization, risk classification, previous operations in the history and tumor origin (P > 0.05). The operation time, fasting time, gastric tube indwelling time, postoperative hospitalization time and postoperative defecation time in the endoscopy group were shorter than those in the laparoscopy group, intraoperative blood loss in the endoscopy group was less than that in the laparoscopy group, the incidence of postoperative complications was 18.37% in the endoscopy group, which was lower than 27.78% in the laparoscopy group, the difference were statistically significant (P < 0.05). The followed up was 13~33 months in the endoscopy group postoperatively, with an average of (23.04 ± 10.38) months. The followed up was 13~35 months in the laparoscopy group postoperatively, with an average of (22.71 ± 10.69) months. There were 4 cases of postoperative recurrence in the endoscopy group, with no metastasis, accounting for 2.04%, there were 8 cases of recurrence and 8 cases of metastasis in the laparoscopy group, accounting for 7.41%. There were 4 cases of damaged tumor bodies in the endoscopy group, accounting for 2.04%, there were 8 cases of damaged tumor bodies in the laparoscopy group, accounting for 3.70%. There were no deaths in either group, and the difference in the above indicators was not significant (P > 0.05).Conclusion Endoscopic surgical treatment for gastric GIST patients with 2~5 cm can reduce intraoperative bleeding, improve postoperative recovery and reduce the occurrence of postoperative complications with good safety, which can be clinically promoted.