【作者】 高健；

【导师】 马志明；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2024， 硕士

【摘要】 目的:探讨腹腔镜胃壁浆肌层环周切开+保留功能的技术在治疗胃黏膜下肿瘤中的临床疗效,进一步探讨该技术的可行性、安全性和优劣势。方法:回顾性分析我院胃肠外科2019年1月~2023年6月通过腹腔镜胃壁浆肌层环周切开+保留功能的技术和腹腔镜胃楔形切除术治疗SMTs患者的临床资料,经过纳入标准和排除标准的筛选后,共计入组83例。根据手术方式不同分为腹腔镜胃壁浆肌层环周切开+保留功能的技术组(研究组,N=33)和腹腔镜胃楔形切除术组(对照组,N=50)。通过搜集患者的影像学检查报告单、病理诊断报告单及术后病程等,获取患者临床资料。通过SPSS 25.0统计软件分析患者的临床资料、围手术期指标及随访结果,以评估腹腔镜胃壁浆肌层环周切开+保留功能的技术切除胃黏膜下肿瘤的临床治疗效果。结果:1)研究组和对照组在年龄、性别、体重指数、营养评分、主诉、肿瘤位置、肿瘤生长方式等方面没有统计学差异(P>0.05)。2)研究组和对照组均获得R 0切除,两组肿瘤包膜完整,病理分型中占比最多的是胃肠道间质瘤。研究组对比对照组在切缘至肿瘤距离方面存在统计学差异(P<0.05),研究组切缘至肿瘤距离更小;但研究组和对照组在肿瘤直径、肿瘤病理分型等方面没有统计学差异(P>0.05)。对于有利部位肿瘤中,研究组和对照组在肿瘤直径、切缘至肿瘤距离和肿瘤病理分型等方面均没有统计学差异(P>0.05)。对于不利部位肿瘤中,研究组对比对照组在切缘至肿瘤距离方面有统计学意义(P<0.05),研究组切缘至肿瘤距离更小;但两组在肿瘤直径和肿瘤病理分型等方面没有统计学差异(P>0.05)。3)研究组患者术后均无贲门或幽门狭窄病例。术后研究组和对照组患者的围术期指标在手术时间、术中出血量、手术切口长度、术后首次排气时间、术后首次进流食时间和术后住院时间等方面没有统计学差异(P>0.05)。结论:1.腹腔镜胃壁浆肌层环周切开技术治疗胃黏膜下肿瘤是安全有效的,具有非劣于胃楔形切除术的临床效果,可以作为一种可行的微创手术选择;2.与腹腔镜胃楔形切除术相比,腹腔镜胃壁浆肌层环周切开技术可以减少不利部位正常胃壁的过量切除,具有一定的临床应用价值;3.在胃粘膜下肿瘤中,胃间质瘤所占比例最高。对于此类肿瘤,胃壁浆肌层环周切开技术可以达到肿瘤学要求的切除范围。更多还原

【Abstract】 Objective: This study explored the clinical efficacy of laparoscopic circumferential seromuscular layer incision plus functional preservation technology in the treatment of gastric submucosal tumors,and further explored the feasibility,safety,advantages and disadvantages of this technology.Methods: We retrospectively analyzed the clinical data of patients with SMTs treated by the technique of serosal and muscular layers incision to preserve gastric function technique in laparoscopic surgery of our hospital from January 2019 to June 2023.After screening for inclusion criteria and exclusion criteria,a total of 83 patients were enrolled.According to different surgical methods,they were divided into laparoscopic circumferential seromuscular layer incision plus functional preservation technology group(study group,N = 33)and extraluminal laparoscopic wedge resection group(control group,N = 50).We obtained the clinical data of the patients by collecting the imaging examination report,pathological diagnosis report and postoperative course of disease.In this study,SPSS 25.0 statistical software was used to analyze the clinical data,perioperative indicators and follow-up results of the patients,so as to evaluate the clinical therapeutic effect of laparoscopic circumferential seromuscular layer incision plus functional preservation technology technique for resection of gastric submucosal tumors.Results:1)There was no significant difference in age,sex,body mass index,nutritional score,chief complaint,tumor location and tumor growth pattern between the study group and the control group(P > 0.05).2)Both the study group and the control group received R 0 resection.The tumor capsule of the two groups was complete,and the most pathological type was gastrointestinal stromal tumors.The study group was more significant than the control group in the distance from the margin to the tumor.However,there was no significant difference in tumor diameter and pathological type between the two groups(P > 0.05).For tumors at favorable sites,there was no significant difference between the study group and the control group in terms of tumor diameter,distance from the margin to the tumor,and tumor pathological classification(P > 0.05).For tumors at unfavorable sites,the study group was significantly different from the control group in terms of the distance from the resection margin to the tumor(P < 0.05),and the distance from the resection margin to the tumor in the study group was smaller.However,there was no significant difference in tumor diameter and pathological type between the two groups(P > 0.05).3)There were no cases of cardiac or pyloric stenosis in the study group.There was no significant difference in perioperative indexes between the study group and the control group in terms of operation time,intraoperative blood loss,length of surgical incision,first postoperative exhaust time,first postoperative feeding time and postoperative hospital stay(P > 0.05).Conclusion: 1.Laparoscopic circumferential seromuscular layer incision technology is safe and effective in the treatment of gastric submucosal tumors,and has a clinical effect that is not inferior to gastric wedge resection,which can be used as a feasible minimally invasive surgical option;2.Compared with gastric wedge resection,laparoscopic circumferential seromuscular layer incision technology can reduce the excessive resection of the normal gastric wall in the adverse site,and has certain clinical application value.3.In gastric submucosal tumors,gastrointestinal stromal tumors accounted for the highest proportion.For such tumors,laparoscopic circumferential seromuscular layer incision technology can achieve the resection range required by oncology.更多还原