中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2014年
9期
973-975
,共3页
杨华%肖刚%周新平%吴国举%赵刚
楊華%肖剛%週新平%吳國舉%趙剛
양화%초강%주신평%오국거%조강
胃肠道间质肿瘤%腹腔镜%胃镜
胃腸道間質腫瘤%腹腔鏡%胃鏡
위장도간질종류%복강경%위경
Gastrointestinal stromal tumors%Laparoscopes%Gastroscopes
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.
目的 探討腹腔鏡聯閤內鏡(LECS)技術治療老年人胃部胃腸道間質瘤(GIST)的可行性、安全性和療效. 方法 對我院胃腸外科2008年1月至2012年12月年齡≥65歲併接受LECS治療的31例胃GIST患者和同期開腹手術的23例患者臨床資料進行迴顧性分析,比較兩組患者手術時間、術中齣血量、手術併髮癥、腫瘤大小、傷口長度、術後胃腸道功能恢複時間、術後住院天數及隨訪數據. 結果 LECS組男17例,女14例,平均年齡(72.8±5.9)歲,29例行胃鏡輔助腹腔鏡胃部分切除術,2例行腹腔鏡輔助胃鏡剝離術,手術均穫得成功,無中轉開腹和死亡患者.開腹手術組男13例,女10例,平均年齡(73.3±6.1)歲.LECS組患者平均手術時間、平均齣血量、平均腫瘤大小、平均切口長度、平均首次排氣時間、平均術後住院天數分彆為(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;開腹手術組分彆為(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組手術時間明顯長于開腹手術組(t=4.805,P=0.000),平均齣血量、平均腫瘤大小、切口長度、首次排氣時間、平均術後住院天數均較開腹手術組小(t=3.192、1.831、5.212、2.014、3.519,P=0.002、0.012、0.000、0.015、0.001).術後腫瘤危險度評估:LECS組極低危13例、低危15例、中危3例;開腹手術組極低危4例、低危14例、中危5例,危險度構成比LECS組低于開腹手術組(f=5.630,P=0.017).所有患者隨訪5～53箇月,LECS組死亡5例,開腹手術組肝轉移1例,死亡4例,兩組死亡患者均未死于胃GIST. 結論 LECS技術治療老年人胃GIST較傳統開腹手術安全有效,具有創傷小、恢複快的優勢,近期療效滿意.
목적 탐토복강경연합내경(LECS)기술치료노년인위부위장도간질류(GIST)적가행성、안전성화료효. 방법 대아원위장외과2008년1월지2012년12월년령≥65세병접수LECS치료적31례위GIST환자화동기개복수술적23례환자림상자료진행회고성분석,비교량조환자수술시간、술중출혈량、수술병발증、종류대소、상구장도、술후위장도공능회복시간、술후주원천수급수방수거. 결과 LECS조남17례,녀14례,평균년령(72.8±5.9)세,29례행위경보조복강경위부분절제술,2례행복강경보조위경박리술,수술균획득성공,무중전개복화사망환자.개복수술조남13례,녀10례,평균년령(73.3±6.1)세.LECS조환자평균수술시간、평균출혈량、평균종류대소、평균절구장도、평균수차배기시간、평균술후주원천수분별위(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;개복수술조분별위(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,LECS조수술시간명현장우개복수술조(t=4.805,P=0.000),평균출혈량、평균종류대소、절구장도、수차배기시간、평균술후주원천수균교개복수술조소(t=3.192、1.831、5.212、2.014、3.519,P=0.002、0.012、0.000、0.015、0.001).술후종류위험도평고:LECS조겁저위13례、저위15례、중위3례;개복수술조겁저위4례、저위14례、중위5례,위험도구성비LECS조저우개복수술조(f=5.630,P=0.017).소유환자수방5～53개월,LECS조사망5례,개복수술조간전이1례,사망4례,량조사망환자균미사우위GIST. 결론 LECS기술치료노년인위GIST교전통개복수술안전유효,구유창상소、회복쾌적우세,근기료효만의.
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.
