全腹腔镜下NOSES手术在直肠癌中的应用及近期疗效分析  

Application of total laparoscopic NOSES operation in rectal cancer and short-term effect analysis

作　　者：孙礼山 赵豹[1] 董磊[1] 王学东 SUN Lishan;ZHAO Bao;DONG Lei;WANG Xuedong(Department of Gastrointestinal Surgery, General Hospital of Wanbei Coal & Power Group, Suzhou 234000, China;Department of Clinical Laboratory, Second People's Hospital of Anhui Province, Hefei 230041,China)

机构地区：[1]安徽皖北煤电集团总医院胃肠外科,安徽宿州234000 [2]安徽省第二人民医院检验科,安徽合肥230041

出　　处：《中国肿瘤外科杂志》2021年第3期278-282,共5页Chinese Journal of Surgical Oncology

基　　金：国家自然科学基金(81972834)。

摘　　要：目的研究全腹腔镜下经自然腔道取标本手术(NOSES)在直肠癌中的近期疗效及安全性。方法选取皖北煤电集团总医院2017年4月至2019年4月收治的80例直肠癌患者,依照治疗方法的不同分为对照组和研究组,对照组35例行传统腹腔镜手术治疗,研究组45例行腹腔镜下结肠吻合并NOSES手术治疗,比较两组的手术指标、术后病理指标、疼痛评分、免疫及炎症指标、术后复发及近期生活质量评分情况。结果研究组和对照组术中出血量、淋巴结清扫数量、标本完整度、预防性造口数量、肿瘤最大横径、环周切缘阳性率、术前及术后24、48 h VAS评分、腹腔感染及吻合口瘘并发症发生率比较差异无统计学意义(P>0.05);两组手术时间、肠功能恢复时间、住院时间比较差异有统计学意义(P<0.05)。两组手术前后免疫功能指标CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比较差异无统计学意义(P>0.05);术后1、3、5 d,两组C反应蛋白(CRP)水平均高于术前1 d,且研究组高于对照组,差异有统计学意义(P<0.05)。研究组术后1年的复发率显著低于对照组(2.2%vs.14.3%),术后生活质量显著优于对照组,差异有统计学意义(P<0.05)。结论全腹腔镜下结肠吻合并NOSES手术治疗直肠癌近期效果显著,患者肠道功能恢复快、复发率低,术后近期生活质量明显提升。Objective To study the application and short-term efficacy and safety of rectal cancer specimens taken through natural cavity(NOSES)under total laparoscopic surgery.Methods A total of 80 patients with rectal cancer admitted to General Hospital of Wanbei Coal&Power Group from April 2017 to April 2019 were randomly divided into control group and study group according to different treatment methods.Among them,35 patients in the control group received traditional laparoscopic surgery and the study group 45 patients received routine total laparoscopic resection with small incision and NOSES operation.The surgical index,postoperative pathological index,pain score,inflammation and immune index,postoperative recurrence and recent quality of life scores were compared between the two groups.Results There were no significant differences in intraoperative blood loss,number of lymph node dissection,specimen integrity,number of prophylactic stoma,maximum transverse diameter of tumor,positive rate of perioperative margin,VAS score before and after 24 and 48 h,abdominal infection,and incidence of anastomotic leakage complications between the study group and the control group(P>0.05).There were significant differences in operation time,intestinal function recovery time and hospital stay between the two groups(P<0.05).There were no significant differences in CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)immune function indexes between the study group before and after operation(P>0.05).C-reactive protein(CRP),an inflammatory marker,was firstly increased and then decreased on postoperative 1,3 and 5 days,with statistical significance(P<0.05).The postoperative recurrence rate of the study group was significantly lower than that of the control group(2.2%vs.14.3%),and the postoperative quality of life score was significantly better than that of the control group,with statistical significance(P<0.05).Conclusions The short-term effect of total laparoscopic small incision resection and NOSES operation for rectal cancer is significant,the patient

关 键 词：腹腔镜下结肠吻合技术 经自然腔道取标本手术 直肠癌 近期疗效 

分 类 号：R73[医药卫生—肿瘤]