胃间质瘤内镜下切除与腹腔镜手术的对比分析与安全性研究

目的比较内镜、腹腔镜下对于5 cm以内小型间质瘤治疗临床评估,拟对小型胃间质瘤探寻最佳的治疗方式。方法选取中山大学附属第八医院近4年术后病理确诊的胃间质瘤(肿瘤直径≤5 cm)患者为研究对象,其中139例行内镜治疗(138例行内镜粘膜下剥离术、1例行内镜下全层切除术),55例行独立腹腔镜治疗,针对临床特点、围手术期并发症、术后病理、术后随访等多角度对比分析。结果内镜组与腹腔镜组比较,内镜组在不同瘤体大小组间年龄、性别比例比较差异无统计学意义(P>0.05);胃间质瘤最常见部位为胃底(68%vs.49%),其次为胃体(29%vs.42%);腹腔镜组瘤体直径大于内镜组(1.22±0.72)cm vs.(2.96±1.36)cm,P<0.05]。围手术期间术后出血、发热、穿孔、腹膜炎发生比例接近,术中出血腹腔镜组出血量及手术耗时以及治疗费用均大于内镜组(P<0.05)。术后随访上,只有内镜治疗组内出现病灶溃疡1例(1/139)(P>0.05)。结论采用内镜下切除直径5 cm以内的胃间质瘤是安全可靠的,内镜治疗与腹腔镜治疗疗效接近,但创伤更小、出血等并发症更少,患者治疗负担更轻。

Comparative analysis and safety study of endoscopic resection and laparoscopic surgery for gastric stromal tumors

【Objectives】To compare the treatment of small gastric stromal tumors within 5 cm under independent endoscopy and laparoscopy and to explore the best way to treat small gastric stromal tumors.【Methods】The patients with gastric stromal tumor(tumor diameter≤5 cm)confirmed by postoperative pathology in our hospital in recent 4 years were selected,including 139 cases of endoscopic treatment(138 ESD and 1 EFR),55 cases underwent laparoscopic treatment.Clinical characteristics,perioperative complications,postoperative pathology and postoperative follow-up were compared and analyzed.【Results】Compared with the laparoscopic group,the endoscopic group had no significant difference in age and sex ratio among different tumor size groups(P>0.05);the most common site of gastric stromal tumor was gastric fundus(68%vs.49%),followed by gastric body(29%vs.42%);the diameter of the tumor in the laparoscopic group was larger than that in the endoscopic group(1.22±0.72 cm vs.2.96±1.36 cm,P<0.05).The incidence of bleeding,fever,perforation and peritonitis were similar in perioperative period.Intraoperative bleeding,bleeding volume,operation time and cost of treatment in laparoscopic group were greater than those in endoscopic group(P<0.05).There was no all-cause death during the follow-up period in two groups.Only 1 case(1/139)had lesion ulcers in the endoscopic treatment group with no significant difference(P>0.05).【Conclusion】Endoscopic resection of gastric stromal tumors within 5 cm is safe and reliable.Endoscopic therapy is similar to laparoscopy,but with less trauma,less bleeding and less burden.