Yan Peng, Liu Jiajia, Hu Xin, Liu Junyan, Wu Yixi, Zhao Yongliang, Yu Peiwu, Qian Feng
Department of General Surgery, Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2015 Aug;18(8):808-11.
To compare the efficacy between laparoscopic and open surgery in the treatment of gastric gastrointestinal stromal tumor (gastric GIST), and to explore the feasibility and safety of laparoscopic resection for gastric GIST.
Clinical data of 226 gastric GIST patients confirmed by pathology with maximal tumor diameter less than 10 cm undergoing operation in our department from January 2002 to December 2013 were retrospectively analyzed. Among them, 158 patients received laparoscopic surgery(laparoscopic group), and 68 open surgery (open group). Related indicators of clinical efficacy were compared between the two groups. Laparoscopic group patients were further divided into 4 groups according to chronological order, including 39 patients in group A, 39 in group B, 39 in group C and 41 in group D. Operating time was compared among 4 groups.
Compared with the open group, laparoscopic group had shorter operation time [(138.8±69.2) min vs. (173.3±74.5) min, P=0.001], less intraoperative bleeding [30 ml vs. 125 ml, P=0.000], faster recovery to postoperative first flatus [(3.2±1.1) d vs. (3.8±1.1) d, P=0.000] and resumption of oral intake [(3.9±1.5) d vs. (4.7±1.5) d, P=0.000], and a shorter hospital stay [(8.1±2.3) d vs. (10.0±2.6) d, P=0.001]. The operation time of laparoscopic group A, B, C and D was (181.0±81.2) min, (124.7±57.8) min, (126.9±67.9) min and (123.4±51.8) min respectively, and the difference was statistically significant(F=7.188, P=0.001). Median follow-up time of 226 patients was 32 months(5 to 104 months). In laparoscopic group, 136 cases(86.1%) received follow-up, and the 1-, 3-, and 5-year overall survival were 98.7%, 90.7% and 72.8% respectively. In the open group, 59 cases (86.8%) received follow-up, and the 1-, 3-, and 5-year overall survival were 98.3%, 87.1% and 83.1%, respectively. The survival between two groups were not significantly different(P=0.164).
Laparoscopic surgery removing gastric GIST with a maximal diameter of less than 10 cm is safe and feasible. The learning curve of laparoscopic gastric GIST surgery is about 40 cases.
比较腹腔镜手术与开放手术治疗胃胃肠道间质瘤（胃GIST）的疗效，探讨腹腔镜胃GIST切除术的可行性及安全性。
回顾性分析2002年1月至2013年12月在我科接受手术治疗、病理确诊为胃GIST且肿瘤最大直径小于10 cm的226例患者的临床资料。其中，158例行腹腔镜手术（腹腔镜组），68例行开放手术（开放组）。比较两组临床疗效相关指标。腹腔镜组患者按时间顺序进一步分为4组，A组39例，B组39例，C组39例，D组41例。比较4组手术时间。
与开放组相比，腹腔镜组手术时间更短[（138.8±69.2）分钟 vs.（173.3±74.5）分钟，P = 0.001]，术中出血量更少[30毫升 vs. 125毫升，P = 0.000]，术后首次排气恢复更快[（3.2±1.1）天 vs.（3.8±1.1）天，P = 0.000]，恢复经口进食更快[（3.9±1.5）天 vs.（4.7±1.5）天，P = 0.000]，住院时间更短[（8.1±2.3）天 vs.（10.0±2.6）天，P = 0.001]。腹腔镜A、B、C、D组手术时间分别为（181.0±81.2）分钟、（124.7±57.8）分钟、（126.9±67.9）分钟和（123.4±51.8）分钟，差异有统计学意义（F = 7.188，P = 0.001）。226例患者中位随访时间为32个月（5至104个月）。腹腔镜组136例（86.1%）接受随访，1年、3年和5年总生存率分别为98.7%、90.7%和72.8%。开放组59例（86.8%）接受随访，1年、3年和5年总生存率分别为98.3%、87.1%和83.1%。两组生存率差异无统计学意义（P = 0.164）。
腹腔镜手术切除最大直径小于10 cm的胃GIST安全可行。腹腔镜胃GIST手术的学习曲线约为40例。
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