腹部无切口经肛门取标本腹腔镜下直肠癌根治术治疗早期直肠癌的近期疗效及安全性观察  

Short-term efficacy and safety observation of laparoscopic radical resection of rectal cancer with natural orifice specimen extraction surgery in treating early colorectal cancer

作　　者：张相成[1] 何亚丽[1] 胡义超 朱广生[1] 王福保[1] ZHANG Xiangcheng;HE Yali;HU Yichao;ZHU Guangsheng;WANG Fubao(Department of General Surgery,Pingdingshan First People’s Hospital,Pingdingshan 467000,He’nan,China)

机构地区：[1]平顶山市第一人民医院普外科,河南平顶山4670000

出　　处：《癌症进展》2022年第1期81-84,103,共5页Oncology Progress

摘　　要：目的观察腹部无切口经肛门取标本(NOSES)腹腔镜下直肠癌根治术治疗早期直肠癌的疗效及安全性。方法将420例早期直肠癌患者按取标本途径不同分为传统腹腔镜直肠癌根治术(LACR)组(320例)和NOSES组(100例)。观察两组患者手术一般情况、应激指标、术后肛门功能、并发症发生情况以及生活质量的差异。结果NOSES组患者术中出血量明显少于LACR组,术后下床时间、住院时间均明显短于LACR组,手术时间明显长于LACR组,差异均有统计学意义(P﹤0.01)。术后1天,两组患者皮质醇、肿瘤坏死因子-α(TNF-α)水平均高于本组术前(P﹤0.05),但NOSES组患者皮质醇、TNF-α水平均明显低于LACR组(P﹤0.01)。术后3个月,两组患者肛管缩榨压、平均静息压、最大静息压均降低(P﹤0.05),但NOSES组患者平均静息压、最大静息压均明显高于LACR组(P﹤0.01)。术后1周,两组患者健康状况调查简表(SF-36)各维度评分均升高,且NOSES组患者SF-36量表各维度评分均高于LACR组(P﹤0.05)。两组患者并发症总发生率比较,差异无统计学意义(P﹥0.05)。结论NOSES对早期结直肠癌患者的治疗效果较好,可改善术后肛门功能和生活质量,具有良好的应用价值。Objective To observe the therapeutic effect and safety of laparoscopic radical resection of rectal cancer with natural orifice specimen extraction surgery(NOSES)on patients with early colorectal cancer.Method A total of420 patients with early-stage rectal cancer were divided into the traditional laparoscopic radical resection of rectal cancer(LACR)group(320 cases)and NOSES group(100 cases)according to different approaches of collecting specimens.The differences in general operation conditions,stress indicators,postoperative anal function,complications,and quality of life were observed and compared between the two groups.Result The intraoperative blood loss volume in the NOSES group was significantly less than that in the LACR group,and the postoperative ambulation time and hospitalization time were significantly shorter than those in the LACR group,and the operation time was significantly longer than that in the LACR group,the differences were statistically significant(P<0.01).One day after the operation,the levels of cortisol and tumor necrosis factor-α(TNF-α)in the two groups were higher than those before the operation(P<0.05),but the levels of cortisol and TNF-αin the NOSES group were significantly lower than those in the LACR group(P<0.01).At 3 months after the operation,the anal canal compression pressure,mean resting anal pressure,and maximum resting anal pressure in the two groups was decreased(P<0.05),but the mean resting pressure and maximum resting pressure in the NOSES group were significantly higher than those in the LACR group(P<0.01).One week after the operation,the scores of each dimension of the MOS item short-from health survey(SF-36)in the two groups were increased,and the scores of each dimension of the SF-36 scale in the NOSES group were higher than those in the LACR group(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion NOSES,which has a good application value,could pose a good therapeutic effect on patients with

关 键 词：直肠癌 腹部无切口经肛门取标本 腹腔镜下直肠癌根治术 肛门功能 生活质量 

分 类 号：R735.37[医药卫生—肿瘤]