经自然腔道取标本完全腹腔镜下结直肠癌根治术的临床效果分析(附50例报道)  

Clinical analysis of total laparoscopic resection for colorectal cancer by NOSES: a report of 50 cases

作　　者：丁成明[1] 彭健[2] 邱俊 陈杰[2] 赵丹[2] 贾泽明[2] 张洋[2] 杨智 贺军[1] 韩东[1] Cheng-ming Ding1, Jian Peng2, Jun Qiu1, Jie Chen2, Dan Zhao2, Ze-ming Jia2,Yang Zhang2, Zhi Yang2, Jun He1, Dong Han1(1.Department of General Surgery, the First Affiliated Hospital of University of South China, Hengyang,Hunan 421001, China; 2. Department of General Surgery, Xiangya Hospital ofCentral South University, Changsha, Hunan 410008, Chin)

机构地区：[1]南华大学附属第一医院普外科,湖南衡阳421001 [2]中南大学湘雅医院普外科,湖南长沙410008

出　　处：《中国内镜杂志》2018年第6期97-101,共5页China Journal of Endoscopy

基　　金：湖南省自然科学基金项目(No:2017JJ2334);湘雅医院-北大未名临床与康复研究基金项目(No:20160201CF)

摘　　要：目的探讨免腹部辅助切口、经自然腔道取标本法(NOSES)完全腹腔镜下结直肠癌根治术的操作要点、可行性、安全性和近期疗效。方法回顾性分析2016年1月-2017年6月该科50例行NOSES法完全腹腔镜下结直肠癌根治术患者的临床资料。结果 50例患者均顺利施行NOSES法完全腹腔镜下结直肠癌根治术。术中出血量(70.0±23.4)ml,手术时间(140.0±29.0)min,术中清扫淋巴结(14.0±2.3)枚,术后无盆腹腔感染及至随访截止日无肿瘤复发,术后下床时间(2.0±0.5)d,术后肛门排气时间(2.0±0.5)d,术后住院时间(8.5±3.0)d,术后发生吻合口漏1例,术后发生肺部感染0例,术后切缘癌细胞残留率0。所有患者随访3~24个月未见肿瘤局部复发及转移。结论免腹部切口NOSES法完全腹腔镜下结直肠癌根治术在临床上是安全可行,同时具有微创、快速康复、美容效果好和术后并发症少等优点。Objective To investigate the feasibility, safety, operating essentials and the short-term therapeutic effect of total laparoscopic resection for colorectal cancer by Natural Orifice Specimen Extraction（NOSES）. Methods The clinical data of 50 patients underwent total laparoscopic resection for colorectal cancer by NOSES from January 2016 to June 2017 were retrospectively analyzed. Results All of the 50 patients with colorectal cancer successfully received total laparoscopic resection by NOSES. None of the patients had serious postoperative complications and death related to the operation. The average operating time was（140.0 ± 29.0） minutes. The blood loss was（70.0 ± 23.4） ml. The number of lymph nodes harvested were（14.0 ± 2.3）. There was no bacteria infection in abdominopelvic cavity post-operation and no recurrence occurred until the end of postoperative follow-up. Postoperative time of bed rest was（2.0 ± 0.5） days. The time of the first anal exhaust was（2.0 ± 0.5） days. The postoperative hospitalization stay was（8.5 ± 3.0） days. There was none case of lung infection while one case of anastomotic leakage. No cancer cells remained in resection margin. No local recurrence and metastasis was found in all patients after follow-up for 3 to 24 months. Conclusion Total laparoscopic resection for colorectal cancer by NOSES is safe and feasible, and has the advantage of minimally invasive, less pain, rapid rehabilitation, good cosmetic effect and less postoperative complications.

关 键 词：经自然腔道内镜手术(NOSES) 免腹部切口 完全腹腔镜技术 结直肠癌 

分 类 号：R735.35[医药卫生—肿瘤] R735.37[医药卫生—临床医学]