| Objective:To compare and analyze the safety and effectiveness of laparoscopy and digestive endoscopy in the treatment of esophagogastric junction submucosal tumors,discuss the clinical application value of the two kinds of surgery,sum up experience,and provide reference for the selection of future treatment programs for patients.Methods:In this study,patients who underwent laparoscopic endoscopic surgery for SMT at EGJ in our hospital from January 2010 to January 2021 were selected as research objects,and were divided into laparoscopic group and endoscopic group according to their surgical methods.General clinical data(including gender,age,tumor size,tumor number,tumor shape,pathological data and depth of origin,etc.),surgical information(including complete resection rate,surgical cost,surgical duration,surgical complications,length of hospital stay,etc.)and postoperative follow-up of patients were collected and analyzed according to clinicopathological data.The risk factors of surgical complications were also discussed.Results:A total of 29 patients in the endoscopic group and 30 patients in the laparoscopic group were included in this study,and a total of 59 patients with SMT who underwent surgery in our hospital were included.Among the 59 patients collected,there were 26 male patients and 33 female patients.The mean age of the patients in the study was 55.29±10.62 years old,and the size of the tumor removed was 21.15±7.97mm.According to relevant imaging and endoscopic examination,all lesions were located in the musculi propria:among them,26 patients had tumors located in the superficial layer of musculi propria,and 33 patients had tumors located in the deep layer of musculi propria.There were no statistical differences between the two groups in sex ratio,age,tumor size grouping,tumor depth,shape and location,indicating that the two groups were comparable(P>0.05).3.The complete resection rate of patients in the endoscopic group was 96.6%(28/29),and that in the laparoscopic group was 93.3%(28/30).There was no significant difference in the proportion of complete resection between the two groups(P>0.05).Compared with the laparoscopic group,the endoscopic group had a shorter operation time(71.00±8.12min VS 87.13±12.69min,P<0.05)and a shorter hospital stay(7.52±2.73 days VS 9.53±2.92 days,P<0.05).In particular,the duration of endoscopic surgery was significantly lower than that of laparoscopy for tumors located in minor curvature and anterior and posterior walls.The overall complication rate was significantly lower in the endoscopic group than in the laparoscopic group(24.1%VS 63.3%,P<0.05),but there was no difference in complication composition between the two groups.In the endoscopic group,leiomyoma accounted for 37.9%(11/29),stromal tumor 41.4%(12/29)and other types accounted for 20.7%(6/29).Leiomyomas accounted for 46.7%(14/30),stromal tumors for 42.3%(11/30),and other types for 13.3%(4/30)in the laparoscopic group.The pathological types of the two groups were not identical(P>0.05).The total hospitalization cost of the medical group was smaller than that of the surgical group(25266.56 yuan VS 33157.21 yuan),and the difference was statistically significant.Data analysis showed that older age,origin from deep inherent muscle and irregular shape were risk factors for surgery-related complications(P<0.05).The mean age of the complication group was higher than that of the non-complication group(60.65±11.38 years VS 51.06±7.83 years,P<0.05).The complications of deep-seated tumors were greater than those of superficial tumors(60.6%VS 23.1%,P<0.05).Complications of irregular tumors were greater than those of regular tumors(87.5%VS 27.9%,P<0.05).4.Conclusions:1.Laparoscopic and endoscopic treatment of SMT at the EGJ site is safe and effective,and endoscopic treatment has fewer overall complications,lower risk of intraoperative bleeding and infection,lower operating time and hospital stay,and lower overall cost.2.Endoscopic surgery has its unique advantages in terms of operation time,especially in the small bend and posterior wall.3.This study shows that the origin of the deep muscle propria,older age and irregular shape are risk factors for surgical complications... |
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