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内镜黏膜下剥离术与腹腔镜手术治疗2 ~ 5 cm胃间质瘤患者的疗效比较

Comparison of therapeutic effects between endoscopic submucosal dissection and laparoscopic surgery for patients with 2-5 cm gastric stromal tumors

    摘要
  • 摘要:
    背景 目前对于大于2 cm的胃肠间质瘤建议首选外科手术，对于小于2cm的胃间质瘤可酌情开展内镜治疗，但是针对直径2 ~ 5 cm的胃GIST内镜下切除是否安全有效，仍存在不少的争议。
    目的 比较内镜黏膜下剥离术与腹腔镜手术治疗2 ~ 5 cm胃间质瘤患者的疗效及预后。
    方法 回顾性分析2017年1月— 2022年6月分别于解放军总医院第一医学中心消化内科、普通外科诊治的胃肠间质瘤患者的临床资料，根据手术方式将患者分为内镜组和腹腔镜组，以倾向性评分匹配对两组患者基线资料进行1∶1匹配后比较两组结局指标，评价两种手术方式的围术期指标及预后。
    结果 本研究共纳入145例患者，其中内镜组47例，腹腔镜组98例。PSM后两组患者均为41例，男女比例相等，均为男性19例，女性22例。内镜组平均年龄(52.7 ± 9.9)岁，腹腔镜组平均年龄(54.5 ± 10.9)岁。两组患者手术均完整切除肿瘤，术中均无肿瘤破裂，无严重并发症发生。内镜组在手术时间Md(IQR)：71.5(50 ~ 90) min vs 85(60 ~ 120) min，P=0.011、术中出血量Md(IQR)：4(2 ~ 5) mL vs 20(10 ~ 50) mL，P=0.011、住院费用方面Md(IQR): 3.5(2.8 ~ 4.0) w vs 4.3(3.5 ~ 5.7) w，P=0.006优于腹腔镜组，在饮食恢复时间Md(IQR)：4(3 ~ 5)d vs 3(3 ~ 5)d，P=0.038方面差于腹腔镜组，差异有统计学意义。
    结论 内镜下治疗2 ~ 5 cm胃间质瘤与外科治疗的安全性及有效性相当，但具有手术时间短、出血少、住院花费少、保留正常胃结构和功能等优点。

     

    Abstract:
    Background Currently, surgical resection is recommended as the first choice for gastrointestinal stromal tumors (GISTs) larger than 2 cm. Endoscopic treatment may be considered for gastric GISTs smaller than 2 cm. However, for gastric GISTs with a diameter of 2-5 cm, there remains significant debate between surgeons and endoscopists regarding the safety and efficacy of endoscopic resection.
    Objective To compare the efficacy and prognosis of endoscopic submucosal dissection (ESD) and laparoscopic surgery for patients with 2-5 cm gastric GISTs.
    Methods A retrospective analysis was conducted for clinical data from patients with GISTs treated at the Department of Gastroenterology and General Surgery of the First Medical Center of Chinese PLA General Hospital from January 2017 to June 2022. Patients were divided into endoscopy group and laparoscopy group based on the surgical approach. Propensity score matching (PSM) was used to match baseline data 1:1 between the two groups, followed by comparisons of outcomes, perioperative indicators and prognosis were evaluated.
    Results A total of 145 patients were included in this study, with 47 in the endoscopy group and 98 in the laparoscopy group. After PSM, there were 41 patients in each group, with equal gender distribution: 19 males and 22 females. The average age was 52.7 ± 9.9 years in the endoscopy group and 54.5 ± 10.9 years in the laparoscopy group. Complete tumor resection was achieved in both groups, with no intraoperative tumor rupture or serious complications. The endoscopy group showed advantages in operation time Md(IQR): 71.5(50 - 90) min vs 85 (60 - 120) min, P=0.011, intraoperative blood loss Md(IQR): 4(2 - 5)mL vs 20 (10 - 50) mL, P=0.011 and hospitalization cost Md(IQR): 3.5(2.8 - 4.0) ten thousand yuan vs 4.3 (3.5 - 5.7) ten thousand yuan, P=0.006.compared to the laparoscopy group. However, the endoscopy group had a longer time to resume diet Md(IQR): 4(3 - 5) d vs 3(3 - 5) d, P=0.038, with statistically significant differences.
    Conclusion Endoscopic treatment of 2-5 cm gastric GISTs is comparable to surgical treatment in terms of safety and efficacy, with advantages such as shorter operation time, less bleeding, lower hospitalization costs, and preservation of normal gastric structure and function.

     

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