经自然腔道取标本手术与常规腹腔镜手术在左半结肠癌治疗中的疗效对比  

Efficacy comparison of natural orifice specimen extraction surgery(NOSES)and conventional laparoscopic surgery for left colon cancer

作　　者：管子龙 王玉柳明 胡汉卿[1] 张浩[1] 李正梁 徐超[1] 罗康佳 欧苏文 郁雷[1] 汤庆超[1] 黄睿[1] 王贵玉[1] Guan Zilong;Wang Yuliuming;Hu Hanqing;Zhang Hao;Li Zhengliang;Xu Chao;Luo Kangjia;Ou Suwen;Yu Lei;Tang Qingchao;Huang Rui;Wang Guiyu(Department of Colorectal Surgery,the Second Affiliated Hospital of Harbin Medical University,Harbin 150081,China)

机构地区：[1]哈尔滨医科大学附属第二医院结直肠肿瘤外科,150081

出　　处：《中华结直肠疾病电子杂志》2022年第1期36-43,共8页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家科学自然基金(No.81872034);黑龙江科学基金(No.H2017016);陈孝平科技发展基金(No.CXPJJH12000002-2020025);吴阶平医学基金(No.320.6750.19092-41)。

摘　　要：目的对比经自然腔道取标本手术(NOSES)与常规腹腔镜手术在左半结肠癌根治术中的疗效及预后情况,论证NOSES手术的安全性及可行性。方法收集2013年5月至2017年5月就诊于哈尔滨医科大学附属第二医院结直肠肿瘤外科并进行手术治疗的127例左半结肠癌患者的临床资料,包括患者一般基础资料、手术相关资料、术后短期预后资料以及长期随访资料。利用患者的基础信息进行1∶1倾向性得分匹配,进行回顾性分析。结果采用倾向性得分匹配法,两组均纳入48例患者。统计结果显示,NOSES组患者的短期预后明显优于常规腹腔镜组,包括术后排气时间(Z=-2.539,P=0.011),术后进食时间(Z=-4.117,P<0.001),术后住院天数(Z=-5.846,P<0.001),术后1日(Z=9.565,P<0.001)、3日(Z=12.885,P<0.001)、5日(Z=7.053,P<0.001)、7日(Z=2.537,P=0.014)疼痛评分等差异均具有统计学意义;在长期预后患者EORTCQLQ-C30量表评分方面,NOSES患者在总体健康状况(Z=-4.808,P<0.001)、角色功能(Z=-2.476,P=0.013)、情绪功能(Z=-3.075,P=0.002)、认知功能(Z=-2.423,P=0.015)及社会功能(Z=-3.639,P<0.001)等方面均有明显优势。而在肛门功能Parks评分,术后并发症以及生存分析等方面,两组差异均无统计学意义。结论NOSES手术的安全性不劣于常规腹腔镜手术,并且在术后恢复的某些方面上优于常规腹腔镜手术。因此,NOSES手术是安全的,是可行的。Objective To demonstrate the safety and feasibility of natural orifice specimen extraction surgery(NOSES)by comparing the efficacy and prognosis between NOSES and conventional laparoscopic surgery for left colon cancer patients.Methods 127 left colon cancer patients who underwent surgery in the Second Affiliated Hospital of Harbin Medical University from May 2013 to May 2017 were enrolled.Collecting clinical data,includes demographic data,surgical data,short-term and long-term followup data.The general data of the patients was matched by the propensity score matching method 1∶1.The data was retrospectively analyzed.Results After propensity score matching forty-eight patients underwent NOSES and 48 patients underwent laparoscopic surgery.Compared with laparoscopic surgery,NOSES resulted in significantly better short-term prognosis in postoperative exhaust time(Z=-2.539,P=0.011),postoperative feeding time(Z=-4.117,P<0.001),postoperative hospital stay days(Z=-5.846,P<0.001),postoperative pain score of the first day(Z=9.565,P<0.001),third day(Z=12.885,P<0.001),fifth day(Z=7.053,P<0.001)and seventh day(Z=2.537,P=0.014).European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTCQLQ-C30)was applied to evaluate long-term prognosis of two groups,indicating the NOSES group was significantly better in general health condition(Z=-4.808,P<0.001),role function(Z=-2.476,P=0.013),emotional function(Z=-3.075,P=0.002),cognitive function(Z=-2.423,P=0.015),and social function(Z=-3.639,P<0.001).However,there was no statistically significant difference with regards to anal functional Parks score,postoperative complications,and survival analysis(all P>0.05).Conclusions The safety of NOSES operation is no less than that of laparoscopic surgery.Moreover,NOSES operation is superior to conventional laparoscopic surgery in some aspects of postoperative recovery.Therefore,the NOSES operation is safe and feasible.

关 键 词：结直肠肿瘤 腹腔镜 经自然腔道取标本手术(NOSES) 倾向性得分匹配 生存分析 

分 类 号：R735.35[医药卫生—肿瘤]