腹腔镜联合内镜治疗老年人胃部胃肠道间质瘤的效果

摘要

Objective To investigate the feasibility,safety and efficacy of laparoscopic and endoscopic cooperative surgery (LECS) for elderly patients with gastric gastrointestinal stromal tumor (GIST).Methods 54 cases with GIST aged 65 years and over in Department of Gastrointestinal Surgery in Beijing Hospital from Dec.2008 to Dec.2012 were selected.31 cases underwent LECS and 23 cases underwent open surgery.Clinical data including operation time,intraoperative blood loss,complications,tumor size,length of incision,postoperative gastrointestinal function recovery time,postoperative in hospitalization and follow up data were retrospectively analyzed in patients.Results There were 17 males and 14 females in the LECS group,and the mean age was (72.8±5.9)years.29 patients underwent laparoscopic-assisted partial gastrectomy,and 2 cases underwent laparoscopicassisted endoscopic dissection in LECS group.All operations were successful with no conversion to open surgery and death.There were 13 males and 10 females in the open surgery group,and the mean age was(73.3±6.1)years.The mean operation time was longer in LECS group than in open surgery group [(120.6±32.8) min vs.(86.3±33.5) min].The mean intraoperative blood loss,mean tumor size,mean length of incision,mean time of gastrointestinal function recovery,mean postoperative hospitalization were less or smaller in LECS group than in open surgery group [(40±23.4) ml vs.(130±65.6) ml,(2.3±1.2)cm vs.(3.6 ±1.8)cm,(3.6±1.1) cm vs.(14.4±3.5) cm,(47.7± 10.4)h vs.(61.4±11.9)h,(5.1±2.3)d vs.(7.2±2.5)d,respectively,t=3.192,1.831,5.212,2.014,3.519,P=0.002,0.012,0.000,0.015,0.001].According postoperative tumor risk assessment,13 cases were at very low risk,15 cases at low risk and 3 cases at middle risk in LECS group; 4 cases were at very low risk,14 cases at low risk and 5 cases at middle risk in open surgery group.The risk degree was lower in LECS group than in open surgery group (x2 =5.63,P=0.017).During a follow-up of 5 53 months,death without GIST was found in 5 patients in LECS group and 4 cases in open surgery group.Hepatic metastasis was found in 1 case in open surgery group.Conclusions LECS is a safe and feasibility alternative approach for elderly patients with gastric GISTs.It has more minimal invasion,fast recovery and satisfaction with short term outcomes as compared with conventional open surgery.%目的 探讨腹腔镜联合内镜(LECS)技术治疗老年人胃部胃肠道间质瘤(GIST)的可行性、安全性和疗效. 方法 对我院胃肠外科2008年1月至2012年12月年龄≥65岁并接受LECS治疗的31例胃GIST患者和同期开腹手术的23例患者临床资料进行回顾性分析,比较两组患者手术时间、术中出血量、手术并发症、肿瘤大小、伤口长度、术后胃肠道功能恢复时间、术后住院天数及随访数据. 结果 LECS组男17例,女14例,平均年龄(72.8±5.9)岁,29例行胃镜辅助腹腔镜胃部分切除术,2例行腹腔镜辅助胃镜剥离术,手术均获得成功,无中转开腹和死亡患者.开腹手术组男13例,女10例,平均年龄(73.3±6.1)岁.LECS组患者平均手术时间、平均出血量、平均肿瘤大小、平均切口长度、平均首次排气时间、平均术后住院天数分别为(120.6±32.8) min、(50.0±23.4)ml、(2.3±1.2)cm、(3.6±1.1) cm、(47.7±10.4)h、(5.1±2.3)d;开腹手术组分别为(85.3±33.5)min、(140.0±65.6) ml、(3.6±1.8)cm、(14.4±3.5) cm、(61.4±11.9)h、(7.2±2.5) d,LECS组手术时间明显长于开腹手术组(t=4.805,P=0.000),平均出血量、平均肿瘤大小、切口长度、首次排气时间、平均术后住院天数均较开腹手术组小(t=3.192、1.831、5.212、2.014、3.519,P=0.002、0.012、0.000、0.015、0.001).术后肿瘤危险度评估:LECS组极低危13例、低危15例、中危3例;开腹手术组极低危4例、低危14例、中危5例,危险度构成比LECS组低于开腹手术组(f=5.630,P=0.017).所有患者随访5～53个月,LECS组死亡5例,开腹手术组肝转移1例,死亡4例,两组死亡患者均未死于胃GIST. 结论 LECS技术治疗老年人胃GIST较传统开腹手术安全有效,具有创伤小、恢复快的优势,近期疗效满意.