直肠癌经自然腔道取标本手术（NOSES）与传统腹腔镜手术的近期效果研究  

Natural orifice specimen extraction vs conventional laparoscopic surgery for rectal cancer: an exploration of short-term efficacy

作　　者：周冬兵[1] 滕庆 杨选华 蒲敏[1] 吕真冰 李权林[1] 任明扬[1] Zhou Dongbing;Teng Qing;Yang Xuanhua;Pu Min;Lü Zhenbing;Li Quanlin;Ren Mingyang(Department of Gastrointestinal Surgery, The Second Clinical Institute of North Sichuan Medical College, Nanchong Central Hospi? tal, Nanchong 637000, Sichuan, China)

机构地区：[1]川北医学院第二临床学院·南充市中心医院胃肠外科

出　　处：《结直肠肛门外科》2019年第4期436-440,445,共6页Journal of Colorectal & Anal Surgery

基　　金：国家自然科学基金资助项目（81401927）;四川省医学科研课题计划（S15049）

摘　　要：目的对比经自然腔道取标本(NOSES)完全腹腔镜下直肠癌根治术与传统腹腔镜辅助直肠癌根治术患者的术中情况与术后恢复情况,探讨NOSES技术的可行性、安全性及近期疗效。方法回顾性分析2015年1月至2018年9月间在南充市中心医院接受经自然腔道取标本手术的110例直肠癌患者(NOSES组)的临床资料,按纳入和排除标准筛选出同期行传统腹腔镜手术的110例直肠癌患者(传统组)。比较两组术中观察指标、术后病理学指标、术后恢复情况。结果所有患者均按照预期目标完成手术,无中转其他手术方式者。NOSES组的手术时间长于传统组,术后24 h、48 h的VAS评分低于传统组,肠功能恢复较传统组提前,切口脂肪液化及感染发生率低于传统组,差异均有统计学意义(均P <0.05)。两组预防性造口数量、肿瘤最大横径、术中失血量、环周切缘阳性率、标本完整度、淋巴结清扫数量、吻合口漏发生率、腹腔感染发生率等比较,差异均无统计学意义(均P> 0.05)。两组均无下切缘阳性病例。结论 NOSES完全腹腔镜下直肠癌根治术在临床应用中具有疼痛轻、美容效果好、肠道功能恢复快等优点,安全性良好,疗效确切。Objectives To investigate the feasibility, safety and short-term efficacy of natural orifice specimen extraction surgery(NOSES) for rectal cancer. We compared intraoperative and postoperative recovery between patients treated with NOSES and conventional laparoscopic radical resection. Methods We retrospectively analyzed clinical data of 110 patients who received NOSES for laparoscopic radical resection of rectal cancer between January 2015 and September 2018 in Nanchong Central Hospital(NOSES group). One hundred and ten patients who received conventional laparoscopic radical resection during the same period were selected as comparison group according to inclusion and exclusion criteria(laparoscopy group). Intraoperative indices, postoperative pathological findings, and postoperative recovery were compared between the two groups. Results All surgeries were uneventful and there was no conversion. Patients in the NOSES group had significantly longer operation duration, lower postoperative visual analogue scale score at 24 h and 48 h, shorter time to bowel movement, and lower incidence of fat liquefaction of abdominal incision and incision infection(P < 0.05). There was no significant difference between the two groups in prophylactic stoma, maximum transverse diameter of tumors, intraoperative blood loss, positive margin, integrity of specimen, lymph node yield,and incidence of anastomotic leak and abdominal infection(P > 0.05). There was no positive lower margin. Conclusion Laparoscopic radical resection by NOSES was feasible and safe, and associated with fewer pain, better aesthetic outcome, and earlier recovery of bowel movement.

关 键 词：直肠癌 经自然腔道取标本手术 传统腹腔镜手术 

分 类 号：R735.3[医药卫生—肿瘤]