腹腔镜与开腹手术治疗胃间质瘤的临床疗效对比研究
发布时间：2017-12-30 23:17
本文关键词：腹腔镜与开腹手术治疗胃间质瘤的临床疗效对比研究 出处：《山东大学》2016年硕士论文 论文类型：学位论文
【摘要】：目的：对比研究腹腔镜手术与开腹手术治疗原发性局限性胃间质瘤的临床效果,探讨腹腔镜手术治疗原发性局限性胃间质瘤的可行性。方法：对山东大学齐鲁医院普外科2012年4月—2015年4月手术治疗的符合下列入组标准的58例胃间质瘤病人的临床资料进行回顾性分析。入组标准：①肿瘤直径"g1cm或"f10cm；②肿瘤距离幽门或贲门"g3cm(胃镜和超声内镜下检查测定),术中不需要幽门或贲门切除重建者；③不合并其他脏器切除者；④既往无腹部手术史者；⑤术后均经病理、免疫组化检查确诊为胃GIST者。58例中,腹腔镜手术(简称腹腔镜组)31例,肿瘤最小直径1cm,最大直径8.5cm,其中直径等于或大于5cm者10例,无一例中转开腹。开腹手术(简称开腹组)27例,肿瘤最小直径lcm,最大直径8cm,直径等于或大于5cm者12例。两组病人在肿瘤所在部位、年龄范围、性别分布及肿瘤直径等方面,差异无统计学意义(表1,P值0.05)。对腹腔镜组和开腹组总体术中出血量、手术时间、术后住院天数、术后肛门排气时间方面进行对比研究。并对比研究不同肿瘤大小和不同部位胃GIST行腹腔镜手术及开腹手术的疗效。结果：腹腔镜组31例无一例中转开腹。1、不同大小和不同部位的胃GIST患者两组手术及术后情况比较(X±S)见表2。结果显示：①胃GIST小于5cm组,腹腔镜组术后住院时间明显短于开腹组(P0.05),而在手术时间、术中出血量及术后排气时间方面,两组无明显差异(P0.05)；②胃GIST等于或大于5cm组,在手术时间、术中出血量、术后排气时间和术后住院时间方面,腹腔镜组与开腹组相当(P0.05)；③对胃前壁、胃大弯侧、胃小弯侧GIST患者,腹腔镜组术后住院时间明显短于开腹组(PO.05),而手术时间、术中出血量、术后排气时间两组间无显著差异(P0.05)；④胃后壁GIST患者,腹腔镜组手术时间明显短于开腹组(P0.05),而在、术中总出血量、术后肛门排气时间及术后住院天数方面差异不显著(P值0.05)。2、两组病人总的手术及术后情况比较(X±S)见表3.结果显示：腹腔镜组总的手术所用时间和术后住院天数较开腹组明显缩短(P值0.05),而术中出血量、术后排气时间和术后并发症发生率,两组间无明显差异(P0.05)结论：对直径小于5cm或位于胃前壁及胃大小弯侧的胃GIST,腹腔镜手术创伤更小、术后恢复时间更短、术后住院天数短,较开腹手术有优势。对直径等于或大于5cm,等于或小于8.5cm,不影响幽门或责门的胃GIST患者,只要病例选择得当,腹腔镜手术的近期效果优于开腹手术。
[Abstract]:Objective: To compare the effects of laparoscopic surgery and open surgery for the treatment of primary clinical effect of localized gastric stromal tumors, laparoscopic surgery for the treatment of primary localized gastric stromal tumor is feasible. Methods: the clinical data of Department of general surgery of Qilu Hospital of Shandong University from April 2012 to April 2015 with surgical treatment of 58 cases of stomach following the standard group stromal tumor patients were retrospectively analyzed. Inclusion criteria: tumor diameter g1cm or f10cm; the tumor from the pylorus or cardiac g3cm (ultrasonic gastroscopy and endoscopic examination determination), pylorus or cardiac resection and reconstruction do not need surgery; when not combined with other organ resection; and no abdominal surgery; the postoperative pathology and immunohistochemical examination confirmed the diagnosis of gastric GIST in.58 cases, laparoscopic surgery (referred to as the laparoscopic group) 31 cases, tumor minimum diameter 1cm, maximum diameter of 8.5cm, the diameter of In 10 cases or more than 5cm, no cases were converted to laparotomy. Open surgery (the laparotomy group) 27 cases, tumor minimum diameter LCM, maximum diameter of 8cm, 12 cases with a diameter equal to or greater than 5cm. Two groups of patients in the tumor location, age range, gender distribution and tumor diameter, no significant difference the significance (Table 1, P = 0.05). The amount of bleeding, total laparoscopic group and laparotomy group in the operation time, postoperative hospital stay, postoperative anal exhaust time were investigated. The effect and comparison of different tumor size and different parts of the stomach GIST laparoscopic surgery and open surgery. Results: the laparoscopic group none of the 31 cases of laparotomy.1, comparison of different sizes and different parts of the stomach GIST of two groups of patients with surgery and postoperative (X + S) see table 2. shows: the stomach GIST less than the 5cm group, the laparoscopic group postoperative hospitalization time was significantly shorter than the laparotomy group (P0.05), and in 鎵嬫湳鏃堕棿,鏈腑鍑鸿閲忓強鏈悗鎺掓皵鏃堕棿鏂归潰,涓ょ粍鏃犳槑鏄惧樊寮，
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