经自然腔道取标本的腹腔镜结直肠癌手术对于细菌污染及脱落肿瘤细胞播散种植的影响  

Effect of laparoscopic colorectal cancer surgery with natural orifice specimen extraction on the bacterial contamination and dissemination of tumor cells

作　　者：卜君[1] 李念[1] 何山[1] 原红军 邓亨怡[1] 陈琼[1] 伍晓汀 BU Jun;LI Nian;HE Shan;YUAN Hongjun;DENG Hengyi;CHEN Qiong;WU Xiaoting(Department of General Surgery,the Second People′s Hospital of Chengdu,Chengdu 610041,China)

机构地区：[1]成都市第二人民医院普通外科,成都610041

出　　处：《实用医学杂志》2021年第22期2887-2892,共6页The Journal of Practical Medicine

基　　金：四川省卫生和计划生育委员会科研课题(编号:150010)。

摘　　要：目的探讨经自然腔道取标本的腹腔镜结直肠癌手术对于手术区细菌污染及脱落肿瘤细胞种植播散的影响。方法将符合条件的患者随机分为两组:传统腹腔镜组(L组)、经肛门取标本的腹腔镜组(NL组),比较两组相关指标。结果两组各有46例患者纳入研究,两组的一般情况和手术相关指标具有可比性。腹腔灌洗液细菌培养结果在手术开始时和结束时2组间比较差异均无统计学意义(均P> 0.05),各自的组内比较差异均具有统计学意义(P <0.05)。腹腔灌洗液游离肿瘤细胞阳性率在手术开始时和结束时两组间比较差异均无统计学意义(均P> 0.05),各自组内比较差异均有统计学意义(P=0.026,P=0.027);肠腔灌洗液游离肿瘤细胞阳性率在吻合前和吻合后两组间比较和各自的组内比较差异均无统计学意义(均P> 0.05)。术后随访时间3~53个月(平均39.9个月),两组患者无局部复发生存率和无区域淋巴结复发生存率以及无远处转移生存率比较差异均无统计学意义(均P> 0.05)。结论经肛门取标本的腹腔镜结直肠癌手术与传统腹腔镜手术相比,在手术区细菌污染、术中肿瘤细胞脱落种植及肿瘤复发扩散情况无明显差异。Objective To investigate the effects of natural orifice specimen extraction(NOSE)in laparoscopic colorectal cancer(CRC)surgery on bacterial contamination and dissemination of exfoliated tumor cells.Methods Eligible patients were randomly assigned to two groups:the traditional laparoscopic surgery group and the laparoscopic with NOSE group. Related indicators were compared. Results 92 patients were enrolled in the study. There were no significant differences in bacterial culture and the positive rate of free tumor cells in the peritoneal lavage fluids at the beginning and the end of the surgery between the two groups,and the comparisons within each group were statistically significant(P < 0.05). There was no significant difference in the positive rate of free tumor cells in the intestinal lavage fluids before and after anastomosis between the two groups and within each group. The follow-up time was 3 ~ 53 months. There were no significant differences between the two groups in the local relapse-free survival(LRFS),nodal relapse-free survival(NRFS),and distant metastasis-free survival(DMFS). Conclusion Compared with traditional laparoscopic surgery,NOSE showed no significant differences in terms of bacterial contamination at the surgical area,exfoliation and implantation of tumor cells during surgery,and tumor recurrence and dissemination.

关 键 词：自然腔道取标本 腹腔镜 结直肠癌 

分 类 号：R735.3[医药卫生—肿瘤]