机器人辅助下经自然腔道取标本手术应用于乙状结肠癌和直肠癌患者的近期疗效分析  

Robot-assisted natural orifice specimen extraction surgery in pat ients with sigmoid colon cancer and rectal cancer: short-term clinical analysis

作　　者：赵志勋 陈海鹏 郑朝旭 关旭 姜争 刘正 陈田力 吕静芳 魏然 程璞 王锡山 Zhao Zhixun;Chen Haipeng;Zheng Zhaoxu;Guan Xu;Jiang Zheng;Liu Zheng;Chen Tianli;Lyu Jingfang;Wei Ran;Cheng Pu;Wang Xishan(Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center of Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021

出　　处：《中华结直肠疾病电子杂志》2022年第1期77-81,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家自然科学基金面上项目(No.82072732);北京市科技计划(No.D171100002617004)。

摘　　要：目的 探讨机器人辅助下经自然腔道取标本手术(NOSES)应用于乙状结肠癌和直肠癌患者的近期疗效。方法 回顾性分析2021年7月至2021年10月于中国医学科学院肿瘤医院接受机器人辅助的结直肠癌患者31例,包括直肠肿瘤18例,乙状结肠肿瘤13例。所有患者根据术中情况决定手术方式,观察手术和术后恢复情况、术后病理学结果,了解患者术后生存、肿瘤进展情况。结果 31例患者顺利完成手术,17例患者接受NOSES手术,剩余14例采取常规手术方式取标本。NOSES组患者的BMI更低[(22.59±2.70)cm比(25.48±2.34)cm,t=1.142,P=0.004];N分期淋巴结转移率更低(χ^(2)=7.343,P=0.025);术中出血量更少[(24.12±14.17)cm比(35.71±11.58)cm,t=0.896,P=0.020],并且术后首次离床活动时间更早[(27.41±10.95)cm比(40.00±9.51)cm,t=1.227,P=0.002]。31名患者在围手术期内均未发生手术相关并发症。术后随访时间3~6个月,所有患者均未发生肿瘤复发、进展和死亡。结论 机器人辅助下NOSES应用于乙状结肠癌和直肠癌患者安全可行,近期疗效满意。Objective To investigate the short-term efficacy of ro botic-assisted natural orifice specimen extraction surgery(NOSES) in patients with sigmoid colon cancer and rectal cancer. Methods A retrospective analysis of 31 patients with colorectal cancer who underwent robotic assistance in the Cancer Hospital of the Chinese Academy of Medical Sciences from July 2021 to October 2021, including 18 cases of rectal tumors and 13 cases of sigmoid colon tumors. All patients received the operation method according to the intraoperative conditions, observe the operation and postoperative recovery, postoperative pathological results, and understand the postoperative survival and tumor progression of the patients. Results 31 patients successfully were performed the operation, 17 patients underwent NOSES operation, and t he remaining 14 patients underwent routine surgery for specimen collection. The patients in the NOSES group had a lower BMI [(22.59±2.70) cm vs.(25.48±2.34) cm, t=1.142, P=0.004];a lower rate of lymph node metastasis in N stage(P=0.025);less intraoperative blood loss [(24.12±14.17) cm vs.(35.71±11.58) cm, t=0.896, P=0.020], and the first time to stand after surgery was earlier [(27.41±10.95) cm vs.(40.00±9.51) cm, t=1.227,P=0.002]. None of the 31 patients had surgery-related complications during the perioperative period. The postoperative follow-up time was 3~6 months, and no tumor recurrence, progression or death occurred in all patients. Conclusion Robot-assisted NOSES is safe and feasible in patients with sigmoid colon cancer and rectal cancer, and the short-term curative effect is satisfactory.

关 键 词：结直肠肿瘤 机器人手术 经自然腔道取标本手术(natural orifice specimen extraction surgery NOSES) 微创手术 

分 类 号：R735.35[医药卫生—肿瘤] R735.37[医药卫生—临床医学]