本文選題：胃間質(zhì)瘤 + 腔外型生長(zhǎng)��； 參考：《浙江大學(xué)》2017年博士論文

【摘要】：研究背景:胃腸道間質(zhì)瘤是世界第五大軟組織肉瘤,在年齡、性別等人口統(tǒng)計(jì)學(xué)因素上,無特別明顯的分布差異。胃腸道間質(zhì)瘤中以胃部最為高發(fā),胃間質(zhì)瘤的手術(shù)切除方法可分為外科手術(shù)(腹腔鏡手術(shù)和開放性手術(shù))與內(nèi)鏡下治療。其中,內(nèi)鏡下治療通過借助內(nèi)鏡技術(shù)實(shí)現(xiàn)胃間質(zhì)瘤的切除,具有微創(chuàng)、便捷等優(yōu)點(diǎn)。一般認(rèn)為,內(nèi)鏡下治療適用于腔內(nèi)型生長(zhǎng)腫瘤的切除,而外科手術(shù)則適合腔外型生長(zhǎng)胃間質(zhì)瘤的治療。隨著內(nèi)鏡下全層切除術(shù)(endoscopic full-thickness resection,EFR)的發(fā)展,已經(jīng)實(shí)現(xiàn)了 5cm以下腔外型生長(zhǎng)胃間質(zhì)瘤的內(nèi)鏡下治療,但對(duì)其切除效果、術(shù)后恢復(fù)等情況仍然存有爭(zhēng)議。因此,針對(duì)腔外型生長(zhǎng)胃間質(zhì)瘤的內(nèi)鏡下治療與外科手術(shù)之間的優(yōu)劣和適用情況仍有待探究。目的:本研究目的旨在比較與分析EFR、腹腔鏡手術(shù)、開放性手術(shù)等不同治療方式對(duì)直徑5cm以下的腔外型生長(zhǎng)胃間質(zhì)瘤患者的療效,為臨床診治腔外型生長(zhǎng)胃間質(zhì)瘤提供依據(jù)。方法:本研究回顧性分析了本中心接受EFR或外科手術(shù)(腹腔鏡手術(shù)和開放性手術(shù))治療的66名直徑5 cm以下的腔外型生長(zhǎng)胃間質(zhì)瘤患者的術(shù)前一般資料、術(shù)中指標(biāo)和術(shù)后指標(biāo)。術(shù)前資料主要包括年齡、性別、合并癥,胃間質(zhì)瘤的瘤體大小和部位。術(shù)中指標(biāo)主要比較了 EFR與外科手術(shù)方式(腹腔鏡手術(shù)和開放性手術(shù))手術(shù)時(shí)間、術(shù)中出血量、腫瘤完整切除率等指標(biāo)。同時(shí)比較了不同手術(shù)方式患者術(shù)后恢復(fù)情況上的差異。結(jié)果:對(duì)術(shù)前資料分析發(fā)現(xiàn),不同手術(shù)方式患者的年齡、性別和合并癥上無顯著差異,但EFR組的瘤體大小顯著小于腹腔鏡手術(shù)組和開放性手術(shù)組。協(xié)方差分析結(jié)果顯示,排除瘤體大小對(duì)結(jié)果的影響,EFR組的手術(shù)時(shí)間和術(shù)中出血量小于腹腔鏡手術(shù)組和開放性手術(shù)組。EFR組在完整切除率、術(shù)后第1天體溫、開放飲食時(shí)間、術(shù)后住院天數(shù)以及并發(fā)癥等方面均不遜于腹腔鏡手術(shù)組和開放性手術(shù)組。EFR術(shù)后不需要留置腹腔引流管,術(shù)后恢復(fù)更快。對(duì)腹腔鏡手術(shù)組內(nèi)病例根據(jù)不同操作難度部位進(jìn)行分組分析發(fā)現(xiàn),腹腔鏡手術(shù)切除不同部位胃間質(zhì)瘤時(shí),手術(shù)時(shí)間、術(shù)中出血量及術(shù)后相關(guān)指標(biāo)均無顯著差異。對(duì)EFR組內(nèi)病例根據(jù)操作者經(jīng)驗(yàn)進(jìn)行分組分析發(fā)現(xiàn),操作者經(jīng)驗(yàn)對(duì)術(shù)中及術(shù)后指標(biāo)無明顯影響。結(jié)論:對(duì)于直徑小于5cm的腔外型生長(zhǎng)胃間質(zhì)瘤,EFR在手術(shù)切除效果上與外科手術(shù)(腹腔鏡手術(shù)和開放性手術(shù))相近,并且具有手術(shù)時(shí)間短、創(chuàng)傷小、恢復(fù)快、并發(fā)癥少等明顯優(yōu)勢(shì),值得臨床進(jìn)一步開展與應(yīng)用。
[Abstract]:Background: gastrointestinal stromal tumor (GIST) is the fifth largest soft tissue sarcoma in the world. Gastrointestinal stromal tumors (GIST) have the highest incidence in the stomach. The surgical methods of GIST can be divided into surgical operation (laparoscopic surgery and open operation) and endoscopic treatment. Among them, endoscopic therapy through endoscopic technology to achieve gastric stromal tumor resection, with the advantages of minimally invasive, convenient and so on. Endoscopic treatment is generally considered to be suitable for resection of intracavitary growth tumors, while surgery is suitable for the treatment of extraluminal gastric stromal tumors. With the development of endoscopic full-thickness resection, endoscopic treatment of ectoplastic gastric stromal tumors under 5cm has been achieved, but the effect of resection and postoperative recovery are still controversial. Therefore, the advantages and disadvantages of endoscopic treatment and surgery for ectopic gastric stromal tumors need to be explored. Objective: to compare and analyze the therapeutic effects of different treatment methods such as EFR, laparoscopic surgery and open surgery on the patients with extraluminal growth stromal tumors (EGIST) under diameter 5cm, and to provide evidence for clinical diagnosis and treatment of ECGTs. Methods: the general data, intraoperative and postoperative data of 66 patients with extraluminal growth stromal tumors under 5 cm diameter treated by EFR or surgery (laparoscopy and open surgery) in our center were retrospectively analyzed. Preoperative data included age, sex, complications, tumor size and location of gastric stromal tumors. Intraoperative parameters were compared between EFR and surgical methods (laparoscopy and open surgery), intraoperative bleeding volume, complete tumor resection rate and so on. At the same time, the difference of postoperative recovery in patients with different surgical methods was compared. Results: there was no significant difference in age, sex and complications among patients with different surgical methods, but the tumor size in EFR group was significantly smaller than that in laparoscopy group and open operation group. The results of covariance analysis showed that the operative time and intraoperative blood loss in EFR group were lower than those in laparoscopy group and open operation group. The complete resection rate, body temperature and open diet time were lower in EFR group than in laparoscopy group and open operation group. The postoperative hospitalization days and complications were not inferior to those in the laparoscopy group and the open operation group. EFR did not need to place a peritoneal drainage tube after operation, and the postoperative recovery was faster than that in the laparoscopy group and the open operation group. The patients in the laparoscopic operation group were divided into two groups according to different difficult parts of operation. The results showed that there was no significant difference in the operative time, the amount of blood loss during the operation and the related indexes after laparoscopic resection of gastric stromal tumors (GIST). The patients in EFR group were divided into groups according to the experience of the operator. The results showed that the experience of the operator had no significant effect on the intraoperative and postoperative indexes. Conclusion: EFR is similar to that of surgery (laparoscopy and open surgery) in excision of extraluminal growth gastric stromal tumors with diameter less than 5cm, and has shorter operative time, less trauma and faster recovery. Fewer complications and other obvious advantages, worthy of further clinical development and application.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2

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