CAJ | 학술논문

目的：比较腹腔镜与开腹手术治疗胃胃肠间质瘤（GIST）的临床疗效，探讨腹腔镜下胃GIST切除术的可行性及安全性。方法回顾性分析2002年1月至2013年12月间在第三军医大学西南医院接受手术治疗的最大径小于10 cm并经病理证实的226例胃GIST患者的临床资料，其中腹腔镜手术158例（腹腔镜组），开腹手术68例（开腹组）。比较两组患者的临床疗效相关指标。再将腹腔镜组患者按照手术先后顺序分为4组（A组39例、B组39例、C组39例和D组41例）以比较其手术的时间。结果与开腹组相比，腹腔镜组患者的手术时间缩短[（138．8±69．2） min比（173．3±74．5） min，P＝0．001]，术中出血减少[30 ml 比125 ml，P＝0．000]，术后首次排气时间[（3．2±1．1） d比（3．8±1．1） d，P＝0．000]和开始进食时间[（3．9±1．5） d比（4．7±1．5） d，P＝0．000]提前，住院时间缩短[（8．1±2．3） d比（10．0±2．6） d，P＝0．001]。腹腔镜A、B、C和D组的手术时间分别为（181．0±81．2） min、（124．7±57．8） min、（126．9±67．9） min和（123．4±51．8） min，差异有统计学意义（P＝0．001）；A组手术时间明显长于其他3组（P＜0．05）。全组中位随访时间32（5～104）月，腹腔镜组随访率86．1％（136／158），1、3、5年生存率分别为98．7％、90．7％和72．8％；开腹组随访率86．8％（59／68），1、3、5年生存率分别为98．3％、87．1％和83．1％；差异无统计学意义（P＝0．164）。结论腹腔镜手术切除最大径小于10 cm的胃GIST是安全可行的。腹腔镜胃GIST手术的学习曲线约为40例。
목적：비교복강경여개복수술치료위위장간질류（GIST）적림상료효，탐토복강경하위GIST절제술적가행성급안전성。방법회고성분석2002년1월지2013년12월간재제삼군의대학서남의원접수수술치료적최대경소우10 cm병경병리증실적226례위GIST환자적림상자료，기중복강경수술158례（복강경조），개복수술68례（개복조）。비교량조환자적림상료효상관지표。재장복강경조환자안조수술선후순서분위4조（A조39례、B조39례、C조39례화D조41례）이비교기수술적시간。결과여개복조상비，복강경조환자적수술시간축단[（138．8±69．2） min비（173．3±74．5） min，P＝0．001]，술중출혈감소[30 ml 비125 ml，P＝0．000]，술후수차배기시간[（3．2±1．1） d비（3．8±1．1） d，P＝0．000]화개시진식시간[（3．9±1．5） d비（4．7±1．5） d，P＝0．000]제전，주원시간축단[（8．1±2．3） d비（10．0±2．6） d，P＝0．001]。복강경A、B、C화D조적수술시간분별위（181．0±81．2） min、（124．7±57．8） min、（126．9±67．9） min화（123．4±51．8） min，차이유통계학의의（P＝0．001）；A조수술시간명현장우기타3조（P＜0．05）。전조중위수방시간32（5～104）월，복강경조수방솔86．1％（136／158），1、3、5년생존솔분별위98．7％、90．7％화72．8％；개복조수방솔86．8％（59／68），1、3、5년생존솔분별위98．3％、87．1％화83．1％；차이무통계학의의（P＝0．164）。결론복강경수술절제최대경소우10 cm적위GIST시안전가행적。복강경위GIST수술적학습곡선약위40례。
Objective 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. Methods 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. Results 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 <br> 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). Conclusions 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.