內鏡粘膜下剝離術和腹腔鏡手術在胃間質瘤治療中有效性及安全性對比研究
發(fā)布時間：2019-06-11 17:02
【摘要】：目的盡管內鏡粘膜下剝離術(Endoscopic submucosal dissection,ESD)在治療在治療胃固有肌層間質瘤中已廣泛應用,然而在其安全性和長期預后方面與傳統的腹腔鏡手術相比仍存在一定的爭議,本研究的目的就是通過回顧性分析和長期隨訪的方法來對兩種手術方法進行對比,以進一步明確內鏡粘膜下剝離術在胃間質瘤治療中的有效性和安全性。方法本研究為多中心回顧性研究,共收集了 2011年3月至2014年12月南京醫(yī)科大學第一附屬醫(yī)院、第二附屬醫(yī)院、附屬淮安一院共335例住院接受手術的間質瘤病例,所有的入組病例瘤體均小于3.5cm,分為內鏡手術組和腹腔鏡手術組,所有病例均經過術后病理的證實,對兩組患者的人口統計學資料、癥狀、腫瘤大小、部位、潛在危險度、手術時間、術中和術后并發(fā)癥、手術花費、術后進食時間、術后住院時間等數據進行全面對比,同時還對入組的患者進行術后的隨訪,記錄其術后恢復情況、有無復發(fā)、有無死亡、死亡原因,進一步對比兩種手術方式對長期預后的影響。結果在335位間質瘤病例中,內鏡手術組262人,腹腔鏡手術組73人,兩者在年齡、性別等人口統計學上無差異性,可看作為均衡可比,內鏡手術組在內鏡手術組的平均腫瘤大小、手術時間、術后進食時間、住院總花費分別為1.33±0.78、62.40±36.94、2.76±1.67、21960.53±6884.53,而腹腔鏡手術組為1.97±0.93、112.81±55.69、4.89±2.03、33027.37±9062.31,在這幾個指標上兩者具有統計學差異,內鏡手術組的手術時間、術后進食時間、手術總花費均優(yōu)于腹腔鏡手術組,內鏡手術組間質瘤大小小于腹腔鏡手術組,而兩者在手術的術中術后并發(fā)癥、死亡率、復發(fā)率上均無明顯統計學差異。結論內鏡粘膜下剝離術作為一種新興發(fā)展的胃間質瘤手術技術,在本研究中提示其在手術花費、手術時間、術后恢復方面較傳統的腹腔鏡手術具有一定的優(yōu)越性,而在術后療效方面并無統計學差異。
[Abstract]:Objective although endoscopic submucous exudation (Endoscopic submucosal dissection,ESD) has been widely used in the treatment of gastric intrinsic myoplasmalemma, there is still some controversy in its safety and long-term prognosis compared with the traditional laparoscopic surgery. The purpose of this study is to compare the two surgical methods by retrospective analysis and long-term follow-up. To further clarify the efficacy and safety of endoscopic submucous exudation in the treatment of gastric stroma. Methods this study was a multicenter retrospective study. From March 2011 to December 2014, 335 cases of Leydig tumors were hospitalized in the first affiliated Hospital of Nanjing Medical University, the second affiliated Hospital and the first affiliated Hospital of Huaian Hospital. All the patients were divided into endoscopic operation group and laparoscopic operation group. All the cases were confirmed by postoperative pathology, and the demographic data of the two groups were statistically analyzed. The data of symptoms, tumor size, location, potential risk, operation time, intraoperative and postoperative complications, operation cost, postoperative eating time and postoperative hospitalization time were compared. At the same time, the patients in the group were followed up, and their postoperative recovery, recurrence, death and causes of death were recorded, and the effects of the two surgical methods on long-term prognosis were further compared. Results there were 262 patients in endoscopic surgery group and 73 patients in laparoscopic surgery group. There was no demographic difference in age and sex between the two groups. The average tumor size, operation time, postoperative eating time and hospitalization cost of endoscopic surgery group were 1.33 鹵0.78, 62.40 鹵36.94, 2.76 鹵1.67, 21960.53 鹵688.53, respectively. The average tumor size, operation time, postoperative eating time and hospitalization cost of endoscopic surgery group were 1.33 鹵0.78, 62.40 鹵36.94, 2.76 鹵1.67, 21960.53 鹵688.53, 1.33 鹵0.78, 62.40 鹵36.94, 2.76 鹵1.67 and 21960.53 鹵688.53, respectively. The laparoscopic operation group was 1.97 鹵0.93112.81 鹵5569, 4.89 鹵2.03, 33027.37 鹵9062.31. There was significant difference in the operation time, postoperative eating time and total operation cost between the endoscopic operation group and the laparoscopic operation group. There was no significant difference in the intraoperative complications, mortality and recurrence rate between the endoscopic operation group and the laparoscopic operation group, but there was no significant difference in the postoperative complications, mortality and recurrence rate between the two groups. Conclusion endoscopic submucous exudation, as a newly developed technique for gastric stroma, suggests that endoscopic submucous exudation has some advantages over traditional laparoscopic surgery in terms of operation cost, operation time and postoperative recovery, but there is no significant difference in postoperative curative effect.
【學位授予單位】：南京醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R735.2
本文編號：2497345
[Abstract]:Objective although endoscopic submucous exudation (Endoscopic submucosal dissection,ESD) has been widely used in the treatment of gastric intrinsic myoplasmalemma, there is still some controversy in its safety and long-term prognosis compared with the traditional laparoscopic surgery. The purpose of this study is to compare the two surgical methods by retrospective analysis and long-term follow-up. To further clarify the efficacy and safety of endoscopic submucous exudation in the treatment of gastric stroma. Methods this study was a multicenter retrospective study. From March 2011 to December 2014, 335 cases of Leydig tumors were hospitalized in the first affiliated Hospital of Nanjing Medical University, the second affiliated Hospital and the first affiliated Hospital of Huaian Hospital. All the patients were divided into endoscopic operation group and laparoscopic operation group. All the cases were confirmed by postoperative pathology, and the demographic data of the two groups were statistically analyzed. The data of symptoms, tumor size, location, potential risk, operation time, intraoperative and postoperative complications, operation cost, postoperative eating time and postoperative hospitalization time were compared. At the same time, the patients in the group were followed up, and their postoperative recovery, recurrence, death and causes of death were recorded, and the effects of the two surgical methods on long-term prognosis were further compared. Results there were 262 patients in endoscopic surgery group and 73 patients in laparoscopic surgery group. There was no demographic difference in age and sex between the two groups. The average tumor size, operation time, postoperative eating time and hospitalization cost of endoscopic surgery group were 1.33 鹵0.78, 62.40 鹵36.94, 2.76 鹵1.67, 21960.53 鹵688.53, respectively. The average tumor size, operation time, postoperative eating time and hospitalization cost of endoscopic surgery group were 1.33 鹵0.78, 62.40 鹵36.94, 2.76 鹵1.67, 21960.53 鹵688.53, 1.33 鹵0.78, 62.40 鹵36.94, 2.76 鹵1.67 and 21960.53 鹵688.53, respectively. The laparoscopic operation group was 1.97 鹵0.93112.81 鹵5569, 4.89 鹵2.03, 33027.37 鹵9062.31. There was significant difference in the operation time, postoperative eating time and total operation cost between the endoscopic operation group and the laparoscopic operation group. There was no significant difference in the intraoperative complications, mortality and recurrence rate between the endoscopic operation group and the laparoscopic operation group, but there was no significant difference in the postoperative complications, mortality and recurrence rate between the two groups. Conclusion endoscopic submucous exudation, as a newly developed technique for gastric stroma, suggests that endoscopic submucous exudation has some advantages over traditional laparoscopic surgery in terms of operation cost, operation time and postoperative recovery, but there is no significant difference in postoperative curative effect.
【學位授予單位】：南京醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R735.2
【參考文獻】
相關期刊論文 前2條
1 Kevin K Roggin;Mitchell C Posner;;Modern treatment of gastric gastrointestinal stromal tumors[J];World Journal of Gastroenterology;2012年46期
2 賀慧穎,項一寧,李燕,鐘鎬鎬,吳秉銓,鄭杰;胃腸道間質瘤60例中c-kit和PDGFRA基因突變的檢測[J];北京大學學報(醫(yī)學版);2005年03期
，本文編號：2497345
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