腹腔镜楔形切除术与胃壁浆肌层环形切开联合黏膜外剥离术治疗贲门区胃间质瘤的疗效对比

Study on efficacy comparison between laparoscopic wedge resection and circular muscle incision with submucosal dissection for cardia gastric stromal tumor

摘要:

目的 比较腹腔镜下楔形切除术与胃壁浆肌层环形切开联合黏膜外剥离术治疗贲门区胃间质瘤的安全性及有效性。方法 回顾性分析2017年1月－2021年12月于该院接受腹腔镜手术的35例贲门区胃间质瘤患者（肿瘤直径2.0～5.0 cm）的临床资料，根据不同术式，将患者分为楔形切除术组（n = 18）和胃壁浆肌层环形切开联合黏膜外剥离术组（n = 17）。比较两组患者围手术期指标（手术时间、术中出血量和中转行扩大手术率、住院时间、住院费用和炎症指标）、术后胃肠功能恢复情况（术后首次排便时间）、并发症和肿瘤学结局（术后3年复发转移情况）。结果 所有患者术后病理均证实切缘为阴性，达到了R0切除。胃壁浆肌层环形切开联合黏膜外剥离术组的手术时间为（115.00±21.14）min，明显长于楔形切除术组的（94.81±17.51）min；胃壁浆肌层环形切开联合黏膜外剥离术组的术中出血量为［10.0（7.5，15.0）］mL，明显少于楔形切除术组的［17.5（10.0，20.0）］mL，差异均有统计学意义（P < 0.05）。胃壁浆肌层环形切开联合黏膜外剥离术组住院费用为（26 888.88±1 912.76）元，明显少于楔形切除术组的（28 741.78±1 377.32）元；胃壁浆肌层环形切开联合黏膜外剥离术组的术后C反应蛋白为（62.13±5.85）mg/L，明显低于楔形切除术组的（69.37±8.45）mg/L；胃壁浆肌层环形切开联合黏膜外剥离术组白细胞为（11.10±0.64）×10⁹/L，明显低于楔形切除术组的（11.83±0.87）×10⁹/L，差异均有统计学意义（P < 0.05）。两组患者中转行扩大手术率、术后首次排便时间、住院时间和并发症发生率比较，差异均无统计学意义（P > 0.05）。术后随访3年，两组患者均无复发或转移病例。结论 腹腔镜下楔形切除术与胃壁浆肌层环形切开联合黏膜外剥离术治疗贲门区胃间质瘤的远期疗效相当。虽然楔形切除术的操作时间较短，但是术中出血量较多，中转行扩大手术率的风险和费用较高；胃壁浆肌层环形切开加黏膜外剥离术具有出血少、术后炎症反应轻和住院费用低等优势，整体更具临床应用价值。

Abstract:

Objective To compare the safety and efficacy of laparoscopic wedge resection and circular incision of the sarcomuscular layer of the gastric wall combined with external mucosal dissection in the treatment of gastric stromal tumor in the cardia region.Methods A retrospective analysis was conducted on the clinical data of 35 patients with gastric stromal tumor in the cardia region (tumor diameters ranging from 2.0 to 5.0 cm) who underwent laparoscopic surgery from January 2017 to December 2021. According to different surgical methods, the patients were divided into the wedge resection group (n = 18) and the circular incision of the gastric wall sarcomuscular layer combined with external mucosal dissection group (n = 17). The perioperative indicators (operation time, blood loss and conversion to extended surgery rate, hospital stay, hospitalization cost, inflammatory indicators), postoperative gastrointestinal function recovery (time of first defecation after surgery), complications and oncological outcomes (recurrence and metastasis 3 years after surgery) of the two groups of patients were compared.Results The postoperative pathology of all patients confirmed that the resection margin was negative, achieving R0 resection. The operation time of the group with circular incision of the gastric wall sarcomuscular layer combined with external mucosal dissection was (115.00 ± 21.14) min, which was significantly longer than that of the wedge resection group (94.81 ± 17.51) min. The intraoperative blood loss in the circular incision of the gastric wall sarcomuscular layer combined with external mucosal dissection group was [10.0 (7.5, 15.0)] mL, which was significantly less than [17.5 (10.0, 20.0)] mL in the wedge resection group, and the differences were statistically significant (P < 0.05). The hospitalization cost of the circular incision of the gastric wall sarcomuscular layer combined combined with external mucosal dissection group was (26 888.88 ± 1 912.76) yuan, which was significantly less than that of the wedge resection group [(28 741.78±1 377.32) yuan]. The postoperative C-reactive protein in the group of circular incision of the gastric wall sarcomuscular layer combined with external mucosal dissection was (62.13 ± 5.85) mg/L, which was significantly lower than that in the wedge resection group [(69.37 ± 8.45) mg/L]. The white blood cell count in the circular incision of the gastric wall sarcomuscular layer combined with external mucosal dissection group was (11.10 ± 0.64)×10⁹/L, which was significantly lower than that in the wedge resection group [(11.83 ± 0.87)×10⁹/L], and the differences were statistically significant (P < 0.05). There were no statistically significant differences in the rates of switching to extended surgery, the time of first defecation after surgery, hospital stay and the incidence of complications between the two groups of patients (P > 0.05). The patients in both groups were followed up for 3 years after the operation, and there were no cases of recurrence or metastasis.Conclusion The long-term efficacy of laparoscopic wedge resection combined with circular incision of the sarcomuscular layer of the gastric wall and external mucosal dissection in the treatment of gastric stromal tumor in the cardia region is comparable. Although the operation time of wedge resection is relatively short, the intraoperative blood loss is relatively large, and the risk and cost of converting to expanded surgery are relatively high. Circular incision of the sarcomuscular layer of the gastric wall combined with external mucosal dissection has advantages such as less bleeding, mild postoperative inflammatory response and low hospitalization cost, and is more valuable for clinical application overall.