左半结肠肿瘤NOSES手术的临床效果研究  

Effect of natural orifice specimen extraction surgery in left-sided colon tumor

作　　者：吴宏宇 黄睿[1] 汤庆超[1] 王猛[1] 胡汉卿[1] 张骞[1] 张宇坤 盛祥宗 王贵玉[1] Wu Hongyu;Huang Rui;Tang Qingchao;Wang Meng;Hu Hanqing;Zhang Qian;Zhang Yukun;Sheng Xiangzong;Wang Guiyu(Department of Colorectal Tumor Surgery,the Second Affiliated Hospital of Harbin Medical University,Harbin 150081,Heilongjiang,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

出　　处：《结直肠肛门外科》2019年第3期259-267,共9页Journal of Colorectal & Anal Surgery

基　　金：吴阶平医学基金会2015-2019(320.6750.15183)

摘　　要：目的探讨NOSES术式在左半结肠肿瘤患者临床治疗中的应用现状及效果。方法回顾性分析本科室2013年5月至2017年5月行经自然腔道取标本手术(NOSES)的48例左半结肠肿瘤患者临床资料,包括术前一般资料、手术相关资料、术后病理资料及随访资料,探讨该术式的可行性及安全性,并将本科室手术操作方法进行展示。结果48例患者平均年龄(58.58±11.52)岁;平均BMI 为(23.0±2.83) kg/m^2;肿瘤位于降结肠28 例(58.33%),降乙交界处14 例(29.16%),结肠脾曲6 例(12.50%);术后病理以中分化腺癌者最多见,共29例(60.41%);术中平均检出淋巴结(11.60±5.90)枚;平均肿瘤最大直径为(3.30±1.32) cm;TNM分期I期8例(16.67%),Ⅱ期17例(35.42%),Ⅲ期19例(39.58%)。本组患者平均手术时间(195.94±74.21) min,平均术中出血量(83.75±43.15) mL;经直肠取标本39例(81.25%),经阴道取标本9例(18.75%);平均术后肛门排气时间(46.19±22.63) h,平均术后开始进食时间(60.51±13.24) h;术后平均住院时间(12.93±8.58) d。随访至2018年12月,随访中位时间为48(21~69)个月,有12例患者出现术后并发症,其中Clavien-Dindo分级Ⅰ&Ⅱ级的患者11例,Ⅲ&Ⅳ级的患者1例(吻合口漏),无肛门及阴道功能异常病例。随访期间死亡16例(33.33%),其中因肿瘤进展导致死亡的患者有3例,非肿瘤因素导致死亡的患者有13例。结论左半结肠肿瘤患者行NOSES术具有良好的可行性、安全性及可靠的近期疗效,有待在今后的临床实践中不断发展和完善,使患者获得更多受益。Objectives To investigate the current use and effect of natural orifice specimen extraction surgery (NOSES) in treat. ing left-sided colon tumor. Methods This was a retrospective analysis of 48 patients with left-sided colon tumor treated in our department between May 2013 and May 2017 by NOSES. The followings were recorded to investigate the feasibility and safety of NOSES, patients’demographics, indices related to surgery, postoperative pathology, and follow-up data. We also demonstrate our procedures in performing NOSES. Results Average age of the 48 patients was (58.58±11.52) years old. Average body mass index was (23.0±2.83) kg/m^2. Tumor was found in descending colon in 28 patients (58.33%), in the junction of descending and sigmoid colon in 14 patients (29.16%), and in the splenic flexure of colon in 6 patients (12.50%). Postoperative pathology showed predominance of moderately differentiated adenocarcinoma (29 patients, 60.41%). Average number of dissected lymph nodes was (11.60±5.90). Average max. tumor diameter was (3.30±1.32) cm. There were 8 patients (16.67%) with TNM stage I, 17 (35.42%) with stage Ⅱ, and 19 (39.58%) with stage Ⅲ. Average duration of surgery was (195.94±74.21) mins and average in.traoperative blood loss was (83.75±43.15) mL. Extraction was performed through rectum (39 patients, 81.25%) and vagina (9 patients, 18.75%). Average time to postoperative anal exhaust was (46.19±22.63) hours, average time to postoperative food intake was (60.51±13.24) hours, and average duration of postoperative hospitalization was (12.93±8.58) days. Patients were followed up until December 2018, with median follow-up duration of 48 months (21 to 69) months. Postoperative complications occurred in 12 patients, among whom 11 were grade Ⅰ&Ⅱ and 1 grade Ⅲ&Ⅳ(anastomotic leakage) according to the Clavien-Dindo Classification for surgical complications. There was no anal or vaginal dysfunction. Sixteen (33.33%) patients died during follow-up, among which three were due to tumor progression a

关 键 词：左半结肠肿瘤 经自然腔道取标本手术 微创外科 临床效果 

分 类 号：R735.3[医药卫生—肿瘤]