内镜粘膜下剥离术和腹腔镜手术在胃间质瘤治疗中有效性及安全性对比研究

发布时间：2019-06-11 17:02

【摘要】：目的尽管内镜粘膜下剥离术(Endoscopic submucosal dissection,ESD)在治疗在治疗胃固有肌层间质瘤中已广泛应用,然而在其安全性和长期预后方面与传统的腹腔镜手术相比仍存在一定的争议,本研究的目的就是通过回顾性分析和长期随访的方法来对两种手术方法进行对比,以进一步明确内镜粘膜下剥离术在胃间质瘤治疗中的有效性和安全性。方法本研究为多中心回顾性研究,共收集了 2011年3月至2014年12月南京医科大学第一附属医院、第二附属医院、附属淮安一院共335例住院接受手术的间质瘤病例,所有的入组病例瘤体均小于3.5cm,分为内镜手术组和腹腔镜手术组,所有病例均经过术后病理的证实,对两组患者的人口统计学资料、症状、肿瘤大小、部位、潜在危险度、手术时间、术中和术后并发症、手术花费、术后进食时间、术后住院时间等数据进行全面对比,同时还对入组的患者进行术后的随访,记录其术后恢复情况、有无复发、有无死亡、死亡原因,进一步对比两种手术方式对长期预后的影响。结果在335位间质瘤病例中,内镜手术组262人,腹腔镜手术组73人,两者在年龄、性别等人口统计学上无差异性,可看作为均衡可比,内镜手术组在内镜手术组的平均肿瘤大小、手术时间、术后进食时间、住院总花费分别为1.33±0.78、62.40±36.94、2.76±1.67、21960.53±6884.53,而腹腔镜手术组为1.97±0.93、112.81±55.69、4.89±2.03、33027.37±9062.31,在这几个指标上两者具有统计学差异,内镜手术组的手术时间、术后进食时间、手术总花费均优于腹腔镜手术组,内镜手术组间质瘤大小小于腹腔镜手术组,而两者在手术的术中术后并发症、死亡率、复发率上均无明显统计学差异。结论内镜粘膜下剥离术作为一种新兴发展的胃间质瘤手术技术,在本研究中提示其在手术花费、手术时间、术后恢复方面较传统的腹腔镜手术具有一定的优越性,而在术后疗效方面并无统计学差异。
[Abstract]:Objective although endoscopic submucous exudation (Endoscopic submucosal dissection,ESD) has been widely used in the treatment of gastric intrinsic myoplasmalemma, there is still some controversy in its safety and long-term prognosis compared with the traditional laparoscopic surgery. The purpose of this study is to compare the two surgical methods by retrospective analysis and long-term follow-up. To further clarify the efficacy and safety of endoscopic submucous exudation in the treatment of gastric stroma. Methods this study was a multicenter retrospective study. From March 2011 to December 2014, 335 cases of Leydig tumors were hospitalized in the first affiliated Hospital of Nanjing Medical University, the second affiliated Hospital and the first affiliated Hospital of Huaian Hospital. All the patients were divided into endoscopic operation group and laparoscopic operation group. All the cases were confirmed by postoperative pathology, and the demographic data of the two groups were statistically analyzed. The data of symptoms, tumor size, location, potential risk, operation time, intraoperative and postoperative complications, operation cost, postoperative eating time and postoperative hospitalization time were compared. At the same time, the patients in the group were followed up, and their postoperative recovery, recurrence, death and causes of death were recorded, and the effects of the two surgical methods on long-term prognosis were further compared. Results there were 262 patients in endoscopic surgery group and 73 patients in laparoscopic surgery group. There was no demographic difference in age and sex between the two groups. The average tumor size, operation time, postoperative eating time and hospitalization cost of endoscopic surgery group were 1.33 卤0.78, 62.40 卤36.94, 2.76 卤1.67, 21960.53 卤688.53, respectively. The average tumor size, operation time, postoperative eating time and hospitalization cost of endoscopic surgery group were 1.33 卤0.78, 62.40 卤36.94, 2.76 卤1.67, 21960.53 卤688.53, 1.33 卤0.78, 62.40 卤36.94, 2.76 卤1.67 and 21960.53 卤688.53, respectively. The laparoscopic operation group was 1.97 卤0.93112.81 卤5569, 4.89 卤2.03, 33027.37 卤9062.31. There was significant difference in the operation time, postoperative eating time and total operation cost between the endoscopic operation group and the laparoscopic operation group. There was no significant difference in the intraoperative complications, mortality and recurrence rate between the endoscopic operation group and the laparoscopic operation group, but there was no significant difference in the postoperative complications, mortality and recurrence rate between the two groups. Conclusion endoscopic submucous exudation, as a newly developed technique for gastric stroma, suggests that endoscopic submucous exudation has some advantages over traditional laparoscopic surgery in terms of operation cost, operation time and postoperative recovery, but there is no significant difference in postoperative curative effect.
【学位授予单位】：南京医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R735.2

【参考文献】