腹腔镜和开腹手术治疗胃间质瘤的安全性及肿瘤学疗效比较

Comparison of safety and oncological outcomes of laparoscopic and open surgery for gastric stromal tumors

摘要:

对比腹腔镜与开腹术治疗胃间质瘤的临床疗效及安全性。方法选取2009 年1 月-2012 年12 月丰南区医院门诊确诊且进行手术治疗的连续胃间质瘤患者为研究对象，按手术方式分为腹腔镜组（58 例）及开腹术组（47 例）。对比两组的围手术期情况、术后恢复情况及随访期生存情况。结果两组的手术方式大致相同（p >0.05），但腹腔镜组的手术时间、术中出血量、恢复肛门排气时间、恢复全流食、半流食的时间、住院时间低于开腹组（p <0.05），其术中风险等级也优于开腹组（p <0.05）；腹腔镜组均快于开腹组（p <0.05）；术后并发症的Clavien-Dinbo评级，腹腔镜组以I、II 级为主，开腹组以II、III 级为主，开腹组的并发症情况较腹腔镜组 更为严重（p <0.05）；此外，开腹组术后进行辅助治疗者的比例高于腹腔镜组（p <0.05）；腹腔镜组复发率6.7%，低于开腹组10.6%，两组相比差异无统计学意义（p >0.05）；3 年无瘤生存率94.5%，高于开腹组，两组相比差异无统计学意义（p <0.05）。结论腹腔镜手术相对于开腹术具备更好的手术安全性与更低的术中风险，有利于促进恢复。其近期肿瘤学疗效与开腹术相当，今后的研究应注重其远期肿瘤学疗效。

Abstract:

To compare the clinical efficacy and safety of laparoscopic and open surgery in the treatment of gastric stromal tumors. Methods The gastric stromal tumor patients diagnosed in Fengnan District Hospital of Tangshan from January 2009 to December 2012 were taken as the research objects. According to the operation methods, the patients were divided into laparoscopy group (58 cases) and laparotomy group (47 cases). The perioperative condition, postoperative recovery and survival were compared between the two groups. Results The operation modes of the two groups were similar (p > 0.05). However, compared to the laparotomy group, the amount of intraoperative bleeding was smaller; the operation time, the time for anal exhaust recovery, the time to retake the full liquid and semi liquid diets, and hospitalization time were significantly shorter in the laparoscopy group (p <0.05); the intraoperative risk level was also superior in the laparoscopy group (p < 0.05). The postoperative recovery in the laparoscopy group was faster than that in the laparotomy group ( p< 0.05). By Clavien-Dinbo rating the postoperative complications in the laparoscopic group were of stage I and II, while those in the laparotomy groupwere of stage II and III, the complications of the laparotomy group were more serious than those of the laparoscopy group (p < 0.05). In addition, the proportion of the patients receiving postoperative adjuvant treatment in the laparotomy group was significantly higher than that in the laparoscopic group (p < 0.05). The recurrence rate was 6.7% in the laparoscopic group which was lower than 10.6% in the laparotomy group; and the three-year diseasefree survival rate was 94.5% in the laparoscopic group, which was higher than that in the laparotomy group, but there were no statistical differences between the two groups (p > 0.05). Conclusions Compared with laparotomy, laparoscopic surgery has better surgical safety and lower intraoperative risk, and is conducive to recovery. Their short-term oncological efficacy is similar. Further research should focus on the long-term efficacy of oncology.