摘要
目的:探究全腹腔镜胃间质瘤切除术的疗效及安全性.方法:回顾性分析2020年1月至2022年6月病理确诊的56例胃间质瘤患者的临床资料,将行全腹腔镜手术患者设为全腹腔镜组(41例),行开腹手术(含直接开腹、腹腔镜探查后开腹和腹腔镜辅助)患者设为开腹组(15例).比较2组患者临床资料、手术并发症、预后;并将患者分为极低危-低危亚组和中危-高危亚组,比较2组中危-高危亚组患者肿瘤大小及术后住院时间.结果:全腹腔镜组肿瘤最大径、最小径均小于开腹组,差异均有统计学意义(P＜0.05);全腹腔镜组有58.5%患者处于低危或极低危,开腹组患者均在中高危,2组胃间质瘤改NIH危险度分级差异有统计学意义(P＜0.05);全腹腔镜组住院时间短于开腹组,差异有统计学意义(P＜0.05).2组患者在年龄、BMI、性别、主刀医师职称、术后进食时间、术后2年预后均无统计学意义(P＞0.05).全腹腔镜组1例术后出现了幽门梗阻,开腹组1例术后出现了呼吸衰竭、胃吻合口狭窄、术后胃瘫、血流感染,对症治疗后均好转出院,术后并发症比较差异无统计学意义(P=0.468).2组中危-高危亚组患者肿瘤最大径、肿瘤最小径和术后住院时间比较差异无统计学意义(P＞0.05).结论:全腹腔镜胃间质瘤切除术可明显缩短患者术后康复时间,在疗效及安全性上不劣于开腹胃间质瘤切除术.
Abstract
Objective:To explore the efficacy and safety of total laparoscopic resection of gastric stromal tumors.Methods:A retrospective analysis was conducted on the clinical data of 56 patients with pathologically confirmed gastric stromal tumors from January 2020 to June 2022.Patients who underwent total laparoscopic surgery were included in the total laparoscopic group(41 cases),and those who underwent open surgery(including direct laparotomy,laparoscopic exploration followed by laparotomy,and laparoscopic-assisted surgery)were included in the open surgery group(15 cases).The clinical data,surgical complications,and prognosis of the two groups were compared.The patients were further divided into very low-risk to low-risk subgroups and intermediate-risk to high-risk subgroups,and the tumor size and postoperative hospital stay of the intermediate-risk to high-risk subgroups in the two groups were compared.Results:The maximum and minimum diameters of the tumors in the total laparoscopic group were smaller than those in the open surgery group,and the differences were statistically significant(P＜0.05),and 58.5%of the patients in the total laparoscopic group were at low risk or very low risk,while all patients in the open surgery group were at intermediate risk or high risk,there was a statistically significant difference in the NIH risk classification between the two groups of gastric stromal tumors(P＜0.05).The postoperative hospital stay in the total laparoscopic group was shorter than that in the open surgery group,and the difference was statistically significant(P＜0.05).There were no statistically significant differences between the two groups in terms of age,BMI,gender,the title of the chief surgeon,postoperative feeding time,and 2-year postoperative prognosis(P＞0.05).One case in the total laparoscopic group developed postoperative pyloric obstruction,and one case in the open surgery group developed postoperative respiratory failure,gastric anastomotic stenosis,postoperative gastroparesis,and bloodstream infection.All patients improved after symptomatic treatment and were discharged.There was no statistically significant difference in postoperative complications between the two groups(P=0.468).There were no statistically significant differences in the maximum and minimum diameters of the tumors and postoperative hospital stay between the intermediate-risk to high-risk subgroups of the two groups(P＞0.05).Conclusion:Total laparoscopic resection of gastric stromal tumors can significantly shorten the postoperative rehabilitation time of patients,and is not inferior to open-abdominal resection of gastric stromal tumors in terms of efficacy and safety.
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