内镜微创与外科手术治疗胃间质瘤临床效果研究

刘茹; 燕善军; 邓敏; 汪建超; 柯希权; 朱玉; 顾林

doi:10.16766/j.cnki.issn.1674-4152.002760

内镜微创与外科手术治疗胃间质瘤临床效果研究

doi: 10.16766/j.cnki.issn.1674-4152.002760

蚌埠医学院第一附属医院消化内科, 安徽蚌埠 233004

基金项目:

安徽省重点研究与开发计划项目 201904a07020022

详细信息

通讯作者:
燕善军，E-mail: yansj2006@163.com

中图分类号: R735.2 R730.56
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出版历程
- 收稿日期: 2022-07-11
- 网络出版日期: 2023-02-07

Clinical effects of endoscopic minimally invasive and surgical treatment of gastric stromal tumours

Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的观察比较内镜微创与外科手术2种方式治疗肿瘤直径≤4 cm的胃间质瘤患者的临床效果。方法回顾性分析2019年3月—2021年3月于蚌埠医学院第一附属医院接受治疗的胃间质瘤患者，根据治疗方式不同分为内镜组和外科组，分析比较2组患者的一般资料、围手术期指标、术后并发症和复发情况。结果纳入128例确诊的胃间质瘤患者。内镜组98例，其中内镜黏膜下剥离术(ESD)57例，内镜下全层切除术(EFR)32例，经内镜黏膜下隧道肿瘤剥离术(STER)5例，内镜黏膜下挖除术(ESE)4例。外科组30例，其中开放性手术4例，腹腔镜下楔形切除10例，腹腔镜下胃大部切除16例。2组患者性别、年龄、BMI、糖尿病等一般资料比较差异无统计学意义(均P＞0.05)。2组患者肿瘤好发部位依次为胃底、胃体、胃窦、贲门，肿瘤直径、免疫组化指标(CD117、DOG-1及CD34阳性率)、NIH(美国国立卫生研究院)危险度、核分裂数等比较差异均无统计学意义(均P＞0.05)。内镜组患者的手术时间、术后首次经口进食时间、术后住院时间和住院费用均显著低于外科组[(63.99±35.19)h vs. (125.10±49.33)h, (2.63±1.03)d vs. (4.90±2.23)d, (6.43±1.54)d vs. (7.67±1.92)d, (27 048.44±4 613.41) 元vs. (49 022.00±9 795.40) 元，均P < 0.05]。内镜组术后发生1例迟发性出血，外科组术后发生1例腹腔感染，均未发生吻合口瘘、腹膜炎等严重术后并发症；术后随访12~36个月，2组均未见复发病例。结论对于肿瘤直径≤4 cm的胃间质瘤，采用内镜下治疗可以获得与外科手术相当的近、远期疗效，在加速术后康复的同时缩短术后住院时间、降低医疗费用。
- 胃间质瘤 /
- 内镜 /
- 微创 /
- 外科手术 /
- 临床效果
Abstract: Objective To observe and compare the clinical effects of endoscopic minimally invasive surgery and surgical surgery on the treatment of gastric stromal tumours with tumour diameter ≤4 cm. Methods Patients with gastric stromal tumour treated at the First Affiliated Hospital of Bengbu Medical College from March 2019 to March 2021 were retrospectively analysed and divided into endoscopic and surgical groups based on the different treatment methods. The general data, perioperative indicators, postoperative complications and recurrence in the two groups were analysed and compared. Results A total of 128 patients with confirmed gastric stromal tumours were included. Exactly 98 cases were included in the endoscopic group, including 57 cases of endoscopic submucosal dissection, 32 cases of endoscopic full-thickness resection, 5 cases of endoscopic submucosal tunneling for tumor dissection and 4 cases of endoscopic submucosal excision. The surgical group comprised 30 cases, including 4 cases of open surgery, 10 cases of laparoscopic wedge resection and 16 cases of laparoscopic subtotal gastrectomy. No significant differences were observed in the gender, age, body mass index (BMI), diabetes and other general data between the two groups (P>0.05). The most common tumor sites in the two groups were fundus, body, antrum and cardia. No significant differences were observed in tumour diameter, immunohistochemical parameters (positive rates of CD117, DOG-1 and CD34), NIH risk and mitotic number between the two groups (all P>0.05). The operation time, postoperative first oral feeding time, postoperative hospital stay and hospitalisation cost of the endoscopic group were significantly lower than those of the surgical group [(63.99±35.19) h vs. (125.10±49.33) h, (2.63±1.03) d vs. (4.90±2.23) d, (6.43±1.54) d vs. (7.67±1.92) d, (27 048.44±4 613.41) yuan vs. (49 022.00±9 795.40) yuan, all P < 0.05]. One case of delayed bleeding occurred in the endoscopic group, and one case of abdominal infection occurred in the surgical group. No serious postoperative complications, such as anastomotic leakage and peritonitis, were observed. During the follow-up period of 12-36 months, no recurrence was found in the two groups. Conclusion For gastric stromal tumours with tumour diameter ≤4 cm, endoscopic treatment can achieve comparable short-term and long-term efficacies with surgery, accelerate postoperative recovery, shorten postoperative hospital stay and reduce medical costs.
- Gastric stromal tumour /
- Endoscopy /
- Minimally invasive /
- Surgery /
- Clinical effect

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表 1 2组GIST患者一般资料比较

组别	例数	性别(例)		年龄 (x±s，岁)	BMI (x±s)	糖尿病 (例)
组别	例数	男性	女性	年龄 (x±s，岁)	BMI (x±s)	糖尿病 (例)
内镜组	98	33	65	59.57±9.41	23.39±1.09	23
外科组	30	13	17	62.23±10.13	23.70±1.29	9
统计量		0.931^a		1.297^b	1.277^b	0.522^a
P值		0.335		0.197	0.204	0.470
注：^a为χ²值，^b为t值。

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表 2 2组GIST患者病理学参数比较

组别	例数	肿瘤部位(例)				肿瘤直径 (x±s，cm)	CD117 (阳性/阴性，例)	DOG-1 (阳性/阴性，例)	CD34 (阳性/阴性，例)	NIH危险度(例)				核分裂数(例)
组别	例数	贲门	胃底	胃体	胃窦	肿瘤直径 (x±s，cm)	CD117 (阳性/阴性，例)	DOG-1 (阳性/阴性，例)	CD34 (阳性/阴性，例)	极低度	低度	中度	高度	≤5	＞5
内镜组	98	7	57	29	5	2.18±0.45	92/6	94/4	96/2	61	35	2	0	65	33
外科组	30	1	13	11	5	2.29±0.53	29/1	29/1	28/2	17	10	2	1	21	9
统计量		5.757^a				1.117^b	0.017^a	0.125^a	1.624^a	4.994^c				0.141^a
P值		0.124				0.266	0.897	0.724	0.234	0.172				0.708
注：^a为χ²值，^b为t值, ^c为Z值。

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表 3 2组GIST患者围手术期指标比较(x±s)

组别	例数	手术时间 (min)	术后首次经口进食时间(d)	术后住院时间 (d)	住院费用 (元)
内镜组	98	63.99±35.19	2.63±1.03	6.43±1.54	27 048.44±4 613.41
外科组	30	125.10±49.33	4.90±2.23	7.67±1.92	49 022.00±9 795.40
t值		7.529	7.754	3.630	16.979
P值		＜0.001	＜0.001	＜0.001	＜0.001

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表 4 2组瘤体直径≤2 cm的GIST患者围手术期指标比较(x±s)

组别	例数	手术时间 (min)	术后首次经口进食时间(d)	术后住院时间 (d)	住院费用 (元)
内镜组	37	73.00±43.04	2.81±1.13	6.16±1.37	27 364.51±4 367.44
外科组	10	131.20±44.88	5.40±2.32	7.70±1.64	52 557.40±6 948.39
t值		3.762	5.024	3.032	14.161
P值		＜0.001	＜0.001	0.004	＜0.001

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表 5 2组瘤体直径2~4 cm的GIST患者围手术期指标比较(x±s)

组别	例数	手术时间 (min)	术后首次经口进食时间(d)	术后住院时间 (d)	住院费用 (元)
内镜组	61	58.52±28.45	2.52±0.96	6.59±1.63	26 856.72±4 781.71
外科组	20	122.05±52.26	4.65±2.21	7.65±2.08	47 254.30±10 663.61
t值		6.913	6.031	2.353	11.838
P值		＜0.001	＜0.001	0.021	＜0.001

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