超重直肠癌患者NOSES手术可行性的影响因素分析  

Analysis of influencing factors on the feasibility of NOSES in overweight patients with rectal cancer

作　　者：刘孟承 黄贲 任志鹏 冷株赟 高玮 朱哲 韩俊毅[2] 周主青[2] 傅传刚 Liu Mengcheng;Huang Ben;Ren Zhipeng;Leng Zhuyun;Gao Wei;Zhu Zhe;Han Junyi;Zhou Zhuqing;Fu Chuangang(Shanghai East Hospital of Clinical Medical College,Nanjing Medical University,Shanghai 210029,China;Department of Colorectal Surgery,Shanghai East Hospital,Tongji University School of Medicine,Shanghai 200120,China)

机构地区：[1]南京医科大学上海东方临床医学院,210029 [2]上海市东方医院胃肠肛肠外科,200120

出　　处：《中华结直肠疾病电子杂志》2021年第3期243-249,共7页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家自然科学基金(No.81773275);上海市浦东新区科学技术委员会科技民生项目(No.PKJ2017-Y17);上海市卫生健康委员会卫生行业临床研究专项(No.202040303)。

摘　　要：目的分析影响超重直肠癌患者经自然腔道取标本手术(NOSES)可行性的临床因素。方法本研究采用回顾性病例对照的研究方法,将上海市东方医院胃肠肛肠外科2017年1月至2019年12月成功行NOSES手术和未成功行NOSES手术的超重(BMI=24~28 kg/m^(2))直肠癌患者纳入研究,并收集年龄、性别、BMI、肿瘤大小、肿瘤梗阻、肿瘤距肛缘距离、直肠系膜厚度等资料。结果本研究共纳入了277例超重直肠癌患者,其中63例(22.7%)成功行NOSES手术。单因素分析显示,女性(χ^(2)=4.332,P=0.037),无肿瘤梗阻(χ^(2)=9.421,P=0.002),肿瘤距肛缘距离<5.0 cm(χ^(2)=23.099,P<0.001),最大肿瘤直径≤5.0 cm(χ^(2)=20.299,P<0.001),直肠系膜前后径厚度(AP)≤6.0 cm(χ^(2)=31.359,P<0.001)以及直肠系膜左右径厚度(LR)≤7.0 cm(χ^(2)=5.754,P=0.016)与NOSES手术成功有关,而年龄(χ^(2)=0.392,P=0.531)和既往腹部手术史(χ^(2)=1.041,P=0.308)等与NOSES手术成功与否无关。多因素logistics回归分析显示,最大肿瘤直径≤5.0 cm(OR=13.73,95%CI:1.81~104.18,P=0.011),肿瘤距肛缘距离<5.0 cm(OR=8.23,95%CI:2.20~30.81,P=0.002),AP≤6.0 cm(OR=3.79,95%CI:1.87~7.66,P<0.001)是超重直肠癌患者NOSES手术成功的独立保护因素。结论最大肿瘤直径,肿瘤距肛缘距离,AP是影响超重直肠癌患者NOSES手术可行性的临床因素,术前综合评估上述因素有助于选择合适的超重直肠癌病例行NOSES手术。Objective To analyze the clinical factors affecting the feasibility of natural orifice specimen extraction surgery(NOSES)in overweight patients with rectal cancer.Methods This research was conducted with the retrospective case-control study.We included overweight(BMI=24~28 kg/m^(2))rectal cancer patients who successfully performed NOSES and who failed to perform NOSES from January 2017 to December 2019 in Shanghai East Hospital,Department of Colorectal Surgery.Clinical data on age,gender,BMI,tumor size,tumor obstruction,tumor distance from the anal verge,mesorectum width was collected.Results A total of 277 overweight patients with rectal cancer were enrolled(63 patients with NOSES).Univariate analysis showed that females(χ^(2)=4.332,P=0.037),no tumor obstruction(χ^(2)=9.421,P=0.002),distance from anal verge<5.0 cm(χ^(2)=23.099,P<0.001),maximum tumor diameter≤5.0 cm(χ^(2)=20.299,P<0.001),mesorectum width in the anteroposterior dimension(AP)≤6.0 cm(χ^(2)=31.359,P<0.001)and mesorectum width from the left to right direction(LR)≤7.0 cm(χ^(2)=5.754,P=0.016)were associated with successful NOSES,however,age(χ^(2)=0.392,P=0.531)or abdominal surgery history(χ^(2)=1.041,P=0.308)was not associated with the feasibility of NOSES.Multivariate logistics regression analysis suggested that the maximum tumor diameter≤5.0 cm(OR=13.73,95%CI:1.81~104.18,P=0.011),distance from anal verge<5.0 cm(OR=8.23,95%CI:2.20~30.81,P=0.002)and AP≤6.0 cm(OR=3.79,95%CI:1.87~7.66,P<0.001)were independent predictive factors of successful NOSES.Conclusion The maximum tumor diameter,distance from anal verge and AP were independent predictive factors of the feasibility of NOSES.Preoperative evaluation of these factors will help identify overweight rectal cancer patients suitable for NOSES.

关 键 词：直肠肿瘤 经自然腔道取标本手术(NOSES) 肿瘤位置 肿瘤大小 BMI 

分 类 号：R735.37[医药卫生—肿瘤]