腹腔镜与开腹手术治疗胃肠间质瘤的疗效对比

目的探讨腹腔镜与开腹手术对胃肠间质瘤（GIST）手术切除的疗效。 方法选择2011年5月至2014年5月收治的胃肠间质瘤患者90例，按照随机数字表法分为腹腔镜组45例和对照组45例，对照组采用传统开腹手术，腹腔镜组行腹腔镜下肿瘤切除术。比较两组患者手术一般情况、术后并发症。术后随访6个月，采用流式细胞仪检测两组患者术前及术后各时段T淋巴细胞CD₃₊、CD₄₊、CD₈₊、CD₄₊/CD₈₊变化水平。 结果与对照组比较，腹腔镜组术中出血量、术后排气时间、术后活动恢复时间、进食时间、住院时间均显著缩短（P<0.05）；两组患者术后主要并发症有胃瘫、伤口脂肪液化、切口感染、肠梗阻、伤口不愈合等，其中腹腔镜组肠梗阻、伤口不愈合发生率显著低于对照组（P<0.05），两组患者术后复发、转移发生率比较差异无统计学意义。两组患者术后1个月时CD₃₊、CD₄₊、CD₄₊/CD₈₊均逐渐降低，CD₈₊逐渐上升，此后CD₃₊、CD₄₊、CD₄₊/CD₈₊逐渐升高，CD₈₊逐渐降低；其中术后各时段腹腔镜组CD₃₊、CD₄₊、CD₄₊/CD₈₊显著高于同时段对照组，CD₈+显著低于同时段对照组（P<0.05）。 结论腹腔镜手术治疗GIST近期疗效优于传统开腹手术，且对患者免疫功能影响更小，有利于患者预后。

Clinical efficacy of laparoscopic and open surgery in treatment of gastrointestinal stromal tumor

ObjectiveTo explore the clinical efficacy and immune function effect of laparoscop-ic and open surgery in treatment of gastrointestinal stromal tumor. MethodsA total of ninety cases of gastrointestinal stromal tumor treated in our hospital from May 2011 to May 2014 were randomly divided into laparoscopic group and control group, with 45 cases in each group. The control group was treated with traditional open operation, while laparoscopic group underwent laparoscopic surgery, and general condi-tions and postoperative complications were compared between two groups after treatment. The two groups were followed up for 6 months, and the levels of T lymphocyte CD₃₊, CD₄₊, CD₈₊, CD₄₊/CD₈₊ were detected by flow cytometry. ResultsCompared with the control group, the amount of bleeding, postoperative ex-haust time, recovery time, eating time, hospitalization time in laparoscopic group were significantly short-ened; the difference between the two groups was statistically significant (P<0.05). The main postoperation complications were gastric paralysis, wound fat liquefaction, incision infection, intestinal obstruction, wound healing, while incidence of intestinal obstruction and wound healing of the laparoscopic group was significantly lower than those of control group (P<0.05). There was statistical difference between the two groups in incidence of postoperative recurrence and metastasis (P<0.05). One month after operation, CD₃₊, CD₄₊, CD₄₊/CD₈₊ levels were gradually decreased, while CD₈₊ level gradually increased, followed by CD₃₊,CD₄₊, CD₄₊/CD₈₊. And CD₃₊, CD₄₊, CD₄₊/CD₈₊ levels in laparoscopic group were significantly higher than control group at the same period after surgery, the CD₈₊ level was significantly lower than that of the con-trol group (P<0.05). ConclusionLaparoscopic surgery is better than the traditional open surgery in the treatment of GIST for smaller influence on the immune function and better prognosis.