134例腹部无辅助切口经造口取标本的直肠癌前切除术(造口借道NOSES手术)近期疗效分析  

Short-term efficacy of laparoscopic anterior resection of rectal cancer with inci?sion-free surgery and specimen extraction via stoma(NOSES with specimen ex?traction via stoma):an analysis of 134 cases

作　　者：杨明 陈海鹏 张麟 马晓龙 关旭 赵志勋 卢召 胡茜玥 姜争 郑朝旭 刘骞 刘正 王锡山 Yang Ming;Chen Haipeng;Zhang Lin;Ma Xiaolong;Guan Xu;Zhao Zhixun;Lu Zhao;Hu Xiyue;Jiang Zheng;Zheng Zhaoxu;Liu Qian;Liu Zheng;Wang Xishan(Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100021,China)

机构地区：[1]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：《结直肠肛门外科》2020年第2期137-142,153,共7页Journal of Colorectal & Anal Surgery

基　　金：北京市科技计划(D171100002617004,腹腔镜技术治疗直肠癌安全性和有效性的应用研究);北京金桥种子基金(ZZ19055)。

摘　　要：目的探讨腹部无辅助切口经造口取标本的直肠癌前切除术(造口借道NOSES手术)的安全性及有效性。方法回顾性分析2016年1月至2019年12月于中国医学科学院北京协和医学院肿瘤医院结直肠外科接受造口借道NOSES手术的134例患者临床资料,总结造口借道NOSES手术、造口还纳手术的操作要点、临床效果,以及随访情况。结果134例患者均顺利完成造口借道NOSES手术,无中转开腹病例。中位手术时间169.0(138.5,210.8)min,中位出血量30(20,50)mL,中位右下腹切口长度4.5(4.0,5.0)cm,中位肿瘤大小4(3,5)cm,术后可视中位切口长度1.2(1.2,2.0)cm,中位术后肛门排气时间2(2,3)d,术后第1天中位疼痛评分3(3,3)分,术后第2天中位疼痛评分2(2,2)分,术后第3天中位疼痛评分1(1,1)分,中位术后住院时间7(6,8)d。截至2019年12月,共113例患者完成还纳手术,还纳中位间隔时间215(149,284)d,中位手术时间79(63,97)min,中位出血量20(10,20)mL,中位切口长度6(6,8)cm,中位术后肛门排气时间3(2,3)d,术后第1天中位疼痛评分3(3,3)分,术后第2天中位疼痛评分2(1,3)分,术后第3天中位疼痛评分1(1,2)分,中位术后住院时间6(5,7)d。造口借道NOSES手术并发症:吻合口狭窄3例,肠梗阻2例,吻合口漏1例,腹腔感染1例。造口相关并发症:粪水性皮炎23例,造口旁疝5例,造口凹陷1例。术后1个月内无二次住院患者及死亡病例。二次还纳手术并发症:切口感染3例,吻合口出血1例。随访发现肝转移3例,肺转移1例,未见局部复发,未见发生腹腔种植及切口种植。结论造口借道NOSES手术安全可行,术中巧妙借用腹壁预防性造口的切口完成标本的取出及抵钉座的置入,可降低NOSES手术难度,易操作、方便推广,该术式在保肛手术中有良好的应用价值。Objectives To investigate the safety and effectiveness of laparoscopic anterior resection of rectal cancer with inci?sion-free surgery and specimen extraction via stoma(NOSES with specimen extraction via stoma).Methods The clinical and pathological data of 134 cases of rectal cancer who received laparoscopic anterior resection of rectal cancer with NOSES with specimen extraction via stoma at the Department of Colorectal Surgery of Cancer Hospital,Chinese Academy of Medical Science&Peking Union Medical College from January 2016 to December 2019 were retrospectively analyzed.The critical points and out?comes of NOSES with specimen extraction via stoma and stoma reversal surgery,and follow-up data were recorded.Results All surgeries were uneventful with no conversion to open surgery.The median operation time was 169.0(138.5,210.8)min,the medi?an intraoperative blood loss was 30(20,50)mL,the median incision length of the lower right abdomen was 4.5(4.0,5.0)cm,the median tumor size was 4(3,5)cm,the postoperative visible median incision length was 1.2(1.2,2.0)cm,the median time to first postoperative flatus was 2(2,3)d,the median pain score was 3(3,3),2(2,2),and 1(1,1)on the first,the second,and the third day after surgery,respectively,the median postoperative hospitalization was 7(6,8)d.As of December 2019,113 patients underwent stoma reversal surgery.The median interval between initial surgery and reversal surgery was 215(149,284)d,the me?dian operation time was 79(63,97)min,the median intraoperative blood loss was 20(10,20)mL,the median incision length was 6(6,8)cm,the median time to first postoperative flatus was 3(2,3)d,the median pain score was 3(3,3),2(1,3),and 1(1,2)on the first,the second,and the third day after surgery,respectively,the median postoperative hospitalization was 6(5,7)d.Com?plications after NOSES with specimen extraction via stoma included anastomotic stenosis(n=3),bowel obstruction(n=2),anastomot?ic leakage(n=1),and abdominal cavity infection(n=1).Stoma-related complications included faecal der

关 键 词：低位直肠癌 经自然腔道取标本手术 造口借道NOSES手术 

分 类 号：R735.37[医药卫生—肿瘤]