腔外型生长胃间质瘤的内镜下全层切除术与外科手术比较

发布时间：2018-06-03 01:27

本文选题：胃间质瘤 + 腔外型生长　；参考：《浙江大学》2017年博士论文

【摘要】：研究背景:胃肠道间质瘤是世界第五大软组织肉瘤,在年龄、性别等人口统计学因素上,无特别明显的分布差异。胃肠道间质瘤中以胃部最为高发,胃间质瘤的手术切除方法可分为外科手术(腹腔镜手术和开放性手术)与内镜下治疗。其中,内镜下治疗通过借助内镜技术实现胃间质瘤的切除,具有微创、便捷等优点。一般认为,内镜下治疗适用于腔内型生长肿瘤的切除,而外科手术则适合腔外型生长胃间质瘤的治疗。随着内镜下全层切除术(endoscopic full-thickness resection,EFR)的发展,已经实现了 5cm以下腔外型生长胃间质瘤的内镜下治疗,但对其切除效果、术后恢复等情况仍然存有争议。因此,针对腔外型生长胃间质瘤的内镜下治疗与外科手术之间的优劣和适用情况仍有待探究。目的:本研究目的旨在比较与分析EFR、腹腔镜手术、开放性手术等不同治疗方式对直径5cm以下的腔外型生长胃间质瘤患者的疗效,为临床诊治腔外型生长胃间质瘤提供依据。方法:本研究回顾性分析了本中心接受EFR或外科手术(腹腔镜手术和开放性手术)治疗的66名直径5 cm以下的腔外型生长胃间质瘤患者的术前一般资料、术中指标和术后指标。术前资料主要包括年龄、性别、合并症,胃间质瘤的瘤体大小和部位。术中指标主要比较了 EFR与外科手术方式(腹腔镜手术和开放性手术)手术时间、术中出血量、肿瘤完整切除率等指标。同时比较了不同手术方式患者术后恢复情况上的差异。结果:对术前资料分析发现,不同手术方式患者的年龄、性别和合并症上无显著差异,但EFR组的瘤体大小显著小于腹腔镜手术组和开放性手术组。协方差分析结果显示,排除瘤体大小对结果的影响,EFR组的手术时间和术中出血量小于腹腔镜手术组和开放性手术组。EFR组在完整切除率、术后第1天体温、开放饮食时间、术后住院天数以及并发症等方面均不逊于腹腔镜手术组和开放性手术组。EFR术后不需要留置腹腔引流管,术后恢复更快。对腹腔镜手术组内病例根据不同操作难度部位进行分组分析发现,腹腔镜手术切除不同部位胃间质瘤时,手术时间、术中出血量及术后相关指标均无显著差异。对EFR组内病例根据操作者经验进行分组分析发现,操作者经验对术中及术后指标无明显影响。结论:对于直径小于5cm的腔外型生长胃间质瘤,EFR在手术切除效果上与外科手术(腹腔镜手术和开放性手术)相近,并且具有手术时间短、创伤小、恢复快、并发症少等明显优势,值得临床进一步开展与应用。
[Abstract]:Background: gastrointestinal stromal tumor (GIST) is the fifth largest soft tissue sarcoma in the world. Gastrointestinal stromal tumors (GIST) have the highest incidence in the stomach. The surgical methods of GIST can be divided into surgical operation (laparoscopic surgery and open operation) and endoscopic treatment. Among them, endoscopic therapy through endoscopic technology to achieve gastric stromal tumor resection, with the advantages of minimally invasive, convenient and so on. Endoscopic treatment is generally considered to be suitable for resection of intracavitary growth tumors, while surgery is suitable for the treatment of extraluminal gastric stromal tumors. With the development of endoscopic full-thickness resection, endoscopic treatment of ectoplastic gastric stromal tumors under 5cm has been achieved, but the effect of resection and postoperative recovery are still controversial. Therefore, the advantages and disadvantages of endoscopic treatment and surgery for ectopic gastric stromal tumors need to be explored. Objective: to compare and analyze the therapeutic effects of different treatment methods such as EFR, laparoscopic surgery and open surgery on the patients with extraluminal growth stromal tumors (EGIST) under diameter 5cm, and to provide evidence for clinical diagnosis and treatment of ECGTs. Methods: the general data, intraoperative and postoperative data of 66 patients with extraluminal growth stromal tumors under 5 cm diameter treated by EFR or surgery (laparoscopy and open surgery) in our center were retrospectively analyzed. Preoperative data included age, sex, complications, tumor size and location of gastric stromal tumors. Intraoperative parameters were compared between EFR and surgical methods (laparoscopy and open surgery), intraoperative bleeding volume, complete tumor resection rate and so on. At the same time, the difference of postoperative recovery in patients with different surgical methods was compared. Results: there was no significant difference in age, sex and complications among patients with different surgical methods, but the tumor size in EFR group was significantly smaller than that in laparoscopy group and open operation group. The results of covariance analysis showed that the operative time and intraoperative blood loss in EFR group were lower than those in laparoscopy group and open operation group. The complete resection rate, body temperature and open diet time were lower in EFR group than in laparoscopy group and open operation group. The postoperative hospitalization days and complications were not inferior to those in the laparoscopy group and the open operation group. EFR did not need to place a peritoneal drainage tube after operation, and the postoperative recovery was faster than that in the laparoscopy group and the open operation group. The patients in the laparoscopic operation group were divided into two groups according to different difficult parts of operation. The results showed that there was no significant difference in the operative time, the amount of blood loss during the operation and the related indexes after laparoscopic resection of gastric stromal tumors (GIST). The patients in EFR group were divided into groups according to the experience of the operator. The results showed that the experience of the operator had no significant effect on the intraoperative and postoperative indexes. Conclusion: EFR is similar to that of surgery (laparoscopy and open surgery) in excision of extraluminal growth gastric stromal tumors with diameter less than 5cm, and has shorter operative time, less trauma and faster recovery. Fewer complications and other obvious advantages, worthy of further clinical development and application.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R735.2

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