The Clinical Application Of Laparoscopy Combined With Gastroscopy Resection For Gastric Stromal Tumors

Objective: Gastric stromal tumors are one of the most common mesenchymal tumors in the digestive tract,and surgical resection is still the only way to cure.With the improvement of endoscopic technology and the improvement of medical technology,laparoscopic combined with endoscopic surgery in the application of GIST treatment reported gradually increased.The use of laparoscopic combined gastroscopy GIST can better expose the tumor to the surgical field of view,intraoperative mutual help operation,smooth resection of the hidden parts of the tumor,to avoid excessive removal of normal tissue.This paper retrospectively analyzed the clinical data of laparoscopic combined with endoscopic surgery and traditional laparotomy in the treatment of GIST in recent years to explore the clinical value of laparoscopy combined with endoscopy.Methods: The clinical data from 20 patients with gastric stromal tumors undergone laparoscopy combined with gastroscopy from July 2014 to July2016 were retrospectively analyzed,and compared with 21 patients undergone open surgery at the same period at the Affiliated Hospital of Jining Medical University.Normal information,Operation-related indexes,complications and follow-up results of the patients were compared.Results: 41 surgery was successful.There were no significant differences in gender,age,tumor diameter,tumor location,histological localization,immunohistochemistry,operation mode and NIH risk classification between the two groups(P>0.05).As compared with open surgery group,the estimated blood loss was significantly less in the laparoscopy combined with gastroscopy group.Time to first flatus,removal of the drain tube and mean postoperative hospital stay were significantly shorter in the laparoscopy combined with gastroscopy group(25.75?8.32 vs 36.67?11.76 ml,47.70?17.13 vs 77.71?16.81 h,3.20?0.83vs4.05?0.86 d,6.00?0.92vs6.80?0.75d),There were significant differences between the two groups(P<0.05).However,laparoscopic resection required longer operative time and greater hospital costs(134.0±16.35 vs 91.48±21.50 min,31600.0±2741.49 vs 17285.71±2452.40 y,P<0.05).There were significant differences between two groups(P<0.05).The incidence of postoperative complications in the laparoscopy combined with gastroscopy group was 5.00%,which was significantly lower than that 33.30% in the open surgery group,with significantly difference(?2=5.236,P<0.05).The median follow-up time was 18 months in the laparoscopy combined with gastroscopy group,of which 1 case had local recurrence and death,and no recurrence,metastasis and death occurred.The median follow-up time was 19 months in open surgery group,of which 2 cases of high-risk patients recurrence,1 case of death,the remaining patients without recurrence,metastasis and death.Conclusion : Laparoscopic combined with gastroscopy has obvious advantages in tumor localization and resection for tumor.It has the advantagesof small intraoperative trauma,less complication,high safety and quick recovery of gastrointestinal function after operation.It is worthy of clinical application.