| In recent years,more and more patients who received laparoscopic gastric gastrointestinal stromal tumor(GIST)resection,but for the whole GIST laparoscopic resection,especially non parts of the GIST guidelines recommend its safety and effectiveness is still controversial,through retrospective analysis,meta-analysis between laparoscopic and stromal tumor the control of site guidelines recommend grouping and multi perspective based on the clinical application of laparoscope in the stomach stromal tumor hospital of Southern gastric stromal tumor cases were collected in this study,and summarizes related operation experience and skills.Part one:retrospective analysis of single center of laparoscopic GIST resection Methods:the clinical data of laparoscopic cholecystectomy(GIST)in the southern hospital from January 2004 to November 2015 were retrospectively analyzed.The patients were divided into laparoscopic group and laparotomy group.The total operation time of laparoscopic group was 80.74±38.96min,and the intraoperative blood loss was 28.171±44.99ml.Intraoperative tumor rupture in 3 cases(1.58%).Postoperative anal exhaust time was 2.537±0.88 days,liquid diet was 2.91 ± 1.70 days.Postoperative complications of Grade 1 level in 3 cases,accounting for;Grade level of 6 cases,accounting for 0.3.4%().During the follow-up period(7-107 months),the overall recurrence rate was 1.89%,and the overall survival rate was 98.76%.The laparoscopic group in the operation time(136.02±53.32 VS.81.01±40.38),bleeding(210.56±348.44VS.28.83±46.08),postoperative exhaust(3.69±0.71 VS.2.55±0.86),start eating liquid time(5.06±1.80 VS.2.90±1.59),postoperative hospitalization days(10.98±4.29VS.5.70±2.44)was significantly better than the laparotomy group.The two groups of tumor recurrence and 5 year survival had no significant difference.Part two:meta-analysis of laparoscopic and open surgery for GIST Methods:the related databases were searched and the clinical data were extracted.RevMan software was used for statistical analysis.Heterogeneity test was used in the study,and the fixed effect model or random effect model was used in the combined analysis.Results:the combined statistical results showed that the amount of bleeding was significantly lower than the laparotomy group in the laparoscopic group(WMD-54.21 ml CI-82.65 to-25.77;95%ml;P<0.01).For the first time after eating liquid time in laparoscopic group was significantly earlier than the control group(WMD-1.34 days CI-1.62 to-1.06;95%,P<0.01)after the first semifluid diet time in laparoscopic group was significantly earlier than the laparotomy group(WMD-1.80 days CI-2.18 to-1.42 95%;P<0.01).The postoperative hospitalization time was less than laparotomy in laparoscopic group(WMD-3.68 days CI-4.52 to-2.85 95%;P<0.01).The overall postoperative complications in the laparoscopic group was significantly less than the control group(RR 0.51,95%CI0.32-0.80,P<0.01).The tumor size is less than the laparotomy group in the laparoscopic group(WMD-0.93 cm;95%CI-1.33 to-0.53,P<0.01).During the follow-up period of laparoscopic recurrence risk group was 3.3%(11/330)and in the laparotomy group was 9.3%(32/345).The recurrence rate of laparoscopic group is less than the laparotomy group(RR 0.47,95%CI 0.24-0.93,P=0.03).part three:The comparative study of laparoscopic GIST resection based on different tumor locationMethods:a retrospective analysis of the database of general surgery Nanfang hospital underwent laparoscopic surgery in the treatment of GIST patients with easy part of comparative study,group and group results:the difficult position at the no conversion in two groups.The operation time in two groups(83.86±44.41 vs 80.77±36.46 min,p=0.627),bleeding(27.74±45.2 vs 29.59±41.18 mL,p=0.780),tumor rupture(0.90%vs 2.82%,p=0.322)and postoperative complications(3.74%vs7.04%,p=0.325)had no significant difference.The overall recurrence rate was 1.89%,and there was no significant difference between the two groups.The overall survival rate was 98.76%,and there was no significant difference in survival between the two groups(98.39%vs 98.99%,p=0.623).Conclusion:laparoscopic surgery in the center of mature,laparoscopic surgery can be used not only in the easy parts of the GIST,in the difficult parts of GIST according to the size and location of tumor surgical suitable,also has good clinical effect,compared with open surgery,laparoscopic GIST surgery is safe and effective,suitable for multi Center RCT further proved conclusion. |
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