结直肠肿瘤经自然腔道取出标本手术67例分析  

Natural orifice specimen extraction in colorectal tumor surgery:analysis of 67 cases

作　　者：周仕海[1] 陈宏[1] 张静 雒洪志[1] 冯春在[1] 孙浩 钟思全 Zhou Shihai;Chen Hong;Zhang Jing;Luo Hongzhi;Feng Chunzai;Sun Hao;Zhong Siquan(Department of Tumor Surgery,Zhongshan People’s Hospital,Zhongshan 528403,China;The First Department of Surgery,Zhongshan Tanzhou Hospital,Zhongshan 528467,China)

机构地区：[1]中山市人民医院肿瘤外科,528403 [2]中山市坦洲医院外一科,528467

出　　处：《中华普通外科学文献（电子版）》2021年第5期340-343,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：中山市科技局基金重大项目(2018B1005);中山市科技局基金项目(2020B1082)。

摘　　要：目的通过对结直肠肿瘤经自然腔道取出标本手术(NOSES)病例进行回顾性分析,探讨在基层医院开展结直肠肿瘤NOSES手术的可行性和安全性。方法回顾性分析2019年1月至2020年12月中山市人民医院收治的67例结直肠肿瘤NOSES手术患者的病例资料,探讨NOSES手术的应用价值。结果67例顺利完成手术,肿瘤位于直肠占46.3%(31/67),乙状结肠占44.8%(30/67),其他部位占9.0%(6/67)。标本取出方式:CRC-NOSESⅠ式7例(10.4%),Ⅱ式16例(23.9%),Ⅳ式7例(10.4%),Ⅵ式28例(41.8%),Ⅴ、Ⅶ、Ⅷ式共9例(13.4%)。经直肠肛门取出标本58例(86.6%),经阴道取出标本9例(13.4%)。术后平均住院(7±2.7)d,94.0%(63/67)的患者能在48 h内下床,85.1%(57/67)的患者在72 h内恢复肛门排气,89.6%(60/67)的患者3 d内可进流质饮食,术后发生吻合口出血、吻合口漏、肠梗阻各2、3、2例。结论选择合适的病例施行结直肠肿瘤NOSES手术安全可行,可以减少患者的创伤、缩短住院时间、加速患者康复,值得在基层医院开展。Objective To investigate the feasibility and safety of natural orifice specific extraction surgery(NOSES)for colorectal tumors in primary hospitals.Methods From January 2019 to December 2020,67 cases of colorectal tumor undergoing NOSES in Zhongshan People’s Hospital were retrospectively analyzed to explore the application value of NOSES.Results All the cases successfully completed the operation.46.3%(31/67)of the tumors were located in the rectum,44.8%(30/67)in the sigmoid colon and 9.0%(6/67)in other parts.CRC-NOSESⅠin 7 cases(10.4%),typeⅡin 16 cases(23.9%),typeⅣin 7 cases(10.4%),typeⅥin 28 cases(41.8%),and typesⅤ,Ⅶ,Ⅷin 9 cases(13.4%).Specimens of 58 cases(86.6%)were removed through rectum and anus,and 9 cases(13.4%)were removed through vagina.The average hospital stay was(7±2.7)d after operation.94.0%(63/67)of the patients were off bed within 48 hours,85.1%(57/67)of the patients recovered anal exhaust within 72 hours,89.6%(60/67)could take in liquid diet within 3 days.Anastomotic bleeding,anastomotic leakage and intestinal obstruction occurred in 2,3 and 2 cases respectively.Conclusions It is safe and feasible to select suitable colorectal tumor cases to carry out NOSES.NOSES can reduce patients’trauma,shorten hospital stay and accelerate patients’rehabilitation,which is worthy to be carried out in primary hospitals.

关 键 词：结直肠肿瘤 经自然腔道取出标本 微创 腹腔镜 

分 类 号：R735.34[医药卫生—肿瘤]