基于倾向值匹配法对LA—NOSE左结直肠癌根治术近期疗效分析  

Propensity score matching-based analysis of short-term outcomes of Laparoscopic-assisted Natural Orifice Specimen Extraction for left colorectal cancer radical resection

作　　者：许淑镇 丁志杰[1,2] 张诗峰[1,2] 邱兴烽[1,2] 闫峰[1,2] 袁思波[1,2] 蔡建春[1,2] 

机构地区：[1]厦门大学附属中山医院胃肠外科 [2]厦门大学医学院胃肠肿瘤研究所,361004

出　　处：《中华医学杂志》2016年第20期1578-1581,共4页National Medical Journal of China

基　　金：福建省科技计划引导性项目（2015D008）;福建省卫生系统中青年人才骨干培养项目（2015-ZQN-JC-42）

摘　　要：目的探讨腹腔镜辅助左结直肠癌根治术中采用蔡氏套管器经肛门自然腔道取标本的近期疗效。方法2014年1月至2015年6月厦门大学附属中山医院胃肠外科连续实施123例腹腔镜辅助左结直肠癌根治术，分别经蔡氏套管器和腹壁切口取标本为29例（研究组）和94例（对照组）。用倾向值匹配法匹配23对病例，比较两组临床资料。结果匹配后两组基线资料在组间分布平衡，在远、近切缘距肿瘤距离、环周切缘阴性率、术中估计出血量、术后第2天C-反应蛋白、术后进食流质时间、术后住院时间、住院费和术后肛门功能差异无统计学意义（P〉0．05）。研究组手术时间较长[（237．8±68．1）min比（168．9±47．5）min，P〈0．05]、淋巴结清扫数量较少[（12．4±5．4）个比（16．4±7．2）个，P〈0．05]、术后第2天白细胞较高[（11．7±3．4）×10^9／L比（9．4±2．6）×10^9/L，P〈0．05]，但术后排气时间较短[（2．6±0．7）d比（3．4±0．7）d，P〈0．05]、下床时间较短[（2．3±0．6）d比（3．6±0．7）d，P〈0．05]、术后总并发症率较低（0／23比6／23，P〈0．05）及术后除镇痛泵外止痛药使用率较低（1／20比9／23，P〈0．05）。结论采用蔡氏套管器肛门取标本的腹腔镜辅助左结直肠癌根治术可获得与传统腹腔镜手术同样的效果，且术后疼痛更轻，恢复更快，腹壁美感度佳。Objective To explore short-term outcomes obtained with Laparoscopic-assisted Natural Orifice Specimen Extraction for left colorectal cancer radical resection. Methods A total of 123 patients with left colorectal tumor who had undergone laparoscopic surgery between Jan. 2014 and Jun. 2015 were reviewed. According to surgical approach, transanal specimen extraction using the Cai Tube （study group, n = 29） and trans-abdominal incision specimen extraction （control group, n = 123 ） were studied. Propensity score matching was applied at a ratio of 1：1 comparing the study （n= 23） and control （n= 23） groups. Results The two matched groups had similar baseline characteristics. There was no significant difference in the length of distal or proximal resection margin, the rate of circumferential resection negative margin, the estimated blood loss, the levels of C-reactive protein on 2nd day after surgery, the postoperative time to take liquid, the postoperative hospital day, the hospital fee and the postoperative anal function. The study group presented longer operative time [ （ 237. 8 ± 68.1 ） min vs （ 168.9 ± 47.5 ） rain, P 〈 0. 05 ], less number of lymph nodes dissected （ 12. 4 ± 5.4 vs 16. 4± 7.2, P 〈 0. 05 ） , higher white cell count on 2ndday after surgery [（11.7 ± 3.4） ×10^9/L vs （9.4 ± 2.6） ×10^9/L, P〈 0.05], but quicker postoperative recovery of bowel function [ （ 2. 6 ± 0. 7 ） d vs （ 3.4 ± 0. 7 ） d, P 〈 0. 05 ], shorter postoperative ambulation time [ （ 2. 3± 0. 6 ） d vs （ 3.6 ± 0. 7 ） d, P 〈 0. 05 ], lower rate of postoperative complications （ 0/23 vs 6/23, P 〈 0. 05 ） and lower rate of utilization of painkillers in addition to postoperative analgesia pump （ 1/20 vs 9/23, P 〈 0.05）. Conclusion Laparoscopic-assisted left colorectal cancer radical resection using the Cai Tube is in line with oncologic principle, less pain, quicker recovery and better cosmetic results.

关 键 词：自然腔道内镜手术 结直肠肿瘤 蔡氏套管器 倾向值匹配法 

分 类 号：R735.34[医药卫生—肿瘤]