同时性多原发结直肠癌经自然腔道取标本手术临床分析  

Clinical analysis of synchronous multiple primary colorectal cancer treated by natural orifice specimen extraction surgery

作　　者：王玉柳明 张骞[1] 郁雷[1] 汤庆超[1] 黄睿[1] 陈瑛罡[1] 王贵玉[1] 王锡山 Wang Yuliuming;Zhang Qian;Yu Lei;Tang Qingchao;Huang Rui;Chen Yinggang;Wang Guiyu;Wang Xishan(Department of Colorectal Surgery,The Second Affliated Hospital of Harbin Medical University,Harbin 150081,China;Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]哈尔滨医科大学附属第二医院结直肠肿瘤外科,哈尔滨150081 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021

出　　处：《中华结直肠疾病电子杂志》2018年第4期347-352,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：吴阶平医学基金会资助(No.320-6750-15183);哈尔滨市科技创新人才研究专项资金(No.2012RFQXS054)

摘　　要：目的通过对同时性多原发结直肠癌经自然腔道取标本手术(NOSES)病例进行临床分析,探讨手术的疗效及短期预后。方法纳入2014年9月至2017年3月行NOSES手术的同时性多原发结直肠癌病例10例,收集的资料包括患者一般信息、病理信息、手术资料及随访资料。结果患者平均年龄为(67.0±8.3)岁,平均BMI指数为(22.8±2.5)kg/m2,两处癌灶分别位于右半结肠和直肠的最多见。两处癌灶病理特征存在差异,绝大部分癌灶最大直径<5 cm,平均淋巴结检出总数为(20.1±16.0)枚。手术资料显示平均手术时间为(267.0±99.8)分钟,平均术中出血量为(110.0±76.8)ml。经直肠取标本者占80%,经阴道取标本者占20%。平均术后排气时间为(50.9±17.8)小时,平均术后住院天数为(11.8±3.2)天。仅1例患者出现术后并发症,住院期间无二次手术者。随访资料显示,术后无肛门功能及阴道功能障碍者,术后1年、2年和3年生存率分别为100%、85.7%和66.7%。结论 NOSES术治疗同时性多原发结直肠癌具有良好的疗效及短期预后,但仍需在临床实践中不断探索和发展。ObjectiveTo study the effectiveness and short-term outcome of natural orifice specimen extraction surgery （NOSES） in synchronous multiple primary colorectal cancer by collecting cases in colorectal surgery. MethodsA total of ten cases were collected. All the patients were diagnosed with synchronous multiple primary colorectal cancer and treated by NOSES. The data included demographic data, postoperative pathology data, surgical data and follow-up data. ResultsThe average age of patients was （67.0±8.3） years, the average BMI was （22.8±2.5） kg/m2, most of the two cancer foci were located in right-sided colon and rectal. Pathological characteristics were different between two cancer foci. The average number of lymph node count was （20.1±16.0） and most of the maximum diameter of tumor were less than 5 cm. 80% of the patients were treated with rectal specimen extractions and 20% by vaginal extractions. The average operation time was （267.0±99.8） minutes and the average blood loss was （110.0±76.8） ml. The average postoperative exhaust time was （50.9±17.8） hours and the average postoperative hospital stay was （11.8±3.2） days. Only one case had postoperative complications, none of these cases received reoperation in the period of hospitalization. In addition, the follow-up data showed that no postoperative anal dysfunctionand vaginal dysfunction was detected, the 1-year, 2-year and 3-year survival rates for the entire group were 100.0%, 85.7% and 66.7% respectively. ConclusionNOSES in synchronous multiple primary colorectal cancer seems to have good effect and short-term outcome. This technology still need to be explored in clinical practice in the future.

关 键 词：结直肠肿瘤 同时性多原发结直肠癌 经自然腔道取标本手术 微创外科 

分 类 号：R735.34[医药卫生—肿瘤]