【摘要】：目的盡管內(nèi)鏡粘膜下剝離術(shù)(Endoscopic submucosal dissection,ESD)在治療在治療胃固有肌層間質(zhì)瘤中已廣泛應(yīng)用,然而在其安全性和長(zhǎng)期預(yù)后方面與傳統(tǒng)的腹腔鏡手術(shù)相比仍存在一定的爭(zhēng)議,本研究的目的就是通過(guò)回顧性分析和長(zhǎng)期隨訪(fǎng)的方法來(lái)對(duì)兩種手術(shù)方法進(jìn)行對(duì)比,以進(jìn)一步明確內(nèi)鏡粘膜下剝離術(shù)在胃間質(zhì)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(xué)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(shù)的間質(zhì)瘤病例,所有的入組病例瘤體均小于3.5cm,分為內(nèi)鏡手術(shù)組和腹腔鏡手術(shù)組,所有病例均經(jīng)過(guò)術(shù)后病理的證實(shí),對(duì)兩組患者的人口統(tǒng)計(jì)學(xué)資料、癥狀、腫瘤大小、部位、潛在危險(xiǎn)度、手術(shù)時(shí)間、術(shù)中和術(shù)后并發(fā)癥、手術(shù)花費(fèi)、術(shù)后進(jìn)食時(shí)間、術(shù)后住院時(shí)間等數(shù)據(jù)進(jìn)行全面對(duì)比,同時(shí)還對(duì)入組的患者進(jìn)行術(shù)后的隨訪(fǎng),記錄其術(shù)后恢復(fù)情況、有無(wú)復(fù)發(fā)、有無(wú)死亡、死亡原因,進(jìn)一步對(duì)比兩種手術(shù)方式對(duì)長(zhǎng)期預(yù)后的影響。結(jié)果在335位間質(zhì)瘤病例中,內(nèi)鏡手術(shù)組262人,腹腔鏡手術(shù)組73人,兩者在年齡、性別等人口統(tǒng)計(jì)學(xué)上無(wú)差異性,可看作為均衡可比,內(nèi)鏡手術(shù)組在內(nèi)鏡手術(shù)組的平均腫瘤大小、手術(shù)時(shí)間、術(shù)后進(jìn)食時(shí)間、住院總花費(fèi)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(shù)組為1.97±0.93、112.81±55.69、4.89±2.03、33027.37±9062.31,在這幾個(gè)指標(biāo)上兩者具有統(tǒng)計(jì)學(xué)差異,內(nèi)鏡手術(shù)組的手術(shù)時(shí)間、術(shù)后進(jìn)食時(shí)間、手術(shù)總花費(fèi)均優(yōu)于腹腔鏡手術(shù)組,內(nèi)鏡手術(shù)組間質(zhì)瘤大小小于腹腔鏡手術(shù)組,而兩者在手術(shù)的術(shù)中術(shù)后并發(fā)癥、死亡率、復(fù)發(fā)率上均無(wú)明顯統(tǒng)計(jì)學(xué)差異。結(jié)論內(nèi)鏡粘膜下剝離術(shù)作為一種新興發(fā)展的胃間質(zhì)瘤手術(shù)技術(shù),在本研究中提示其在手術(shù)花費(fèi)、手術(shù)時(shí)間、術(shù)后恢復(fù)方面較傳統(tǒng)的腹腔鏡手術(shù)具有一定的優(yōu)越性,而在術(shù)后療效方面并無(wú)統(tǒng)計(jì)學(xué)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(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.2

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本文編號(hào)：2497345