腹部无辅助切口经直肠切口取标本的腹腔镜右半结肠癌根治术(CRC-NOSES-Ⅷ式B法)近期疗效分析  

Short-term efficacy analysis of laparoscopic right colon cancer radical resection transrectal specimen extraction without abdominal incision(CRC-NOSES-Ⅷtype B)

作　　者：闫顺笠 孙慧敏 郑朝旭 刘正 陈海鹏 关旭 周思成 周海涛 梁建伟 裴炜 王锡山 Shunli Yan;Huimin Sun;Zhaoxu Zheng;Zheng Liu;Haipeng Chen;Xu Guan;Sicheng Zhou;Haitao Zhou;Jianwei Liang;Wei Pei;Xishan Wang(Department of Gastrointestinal Surgery,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang 471000,China;Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]郑州大学附属洛阳中心医院胃肠外科,471000 [2]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3期212-219,共8页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家自然科学基金面上项目(82072732);北京市科技计划(D171100002617004)。

摘　　要：目的探讨经直肠取标本的腹腔镜右半结肠癌根治术(CRC-NOSES-Ⅷ式B法)的安全性、可行性和近期疗效。方法收集2018年1月至2021年4月在中国医学科学院肿瘤医院行腹部无辅助切口经直肠取标本的腹腔镜右半结肠癌根治术和腹腔镜辅助下右半结肠癌根治术患者的临床资料,回顾性分析两种术式对患者术后恢复情况、并发症及病理结果的影响。结果共有15例患者行腹部无辅助切口经直肠取标本的腹腔镜右半结肠癌根治手术(研究组),随机抽取同期符合入组条件的腹腔镜辅助下右半结肠癌根治术男性患者45例设为对照组。研究组和对照组性别、年龄、ASA分级、实验室检查、术前肿瘤大小、部位及TNM分期等差异无统计学意义(P>0.05),BMI指数研究组和对照组之间差异有统计学意义(t=-2.401,P=0.022)。研究组和对照组患者均顺利完成手术,无中转开腹病例,手术时间、术中出血量、肠道功能恢复时间、术后住院天数、术后病理肿瘤最大径、淋巴结检出及阳性个数、肿瘤病理类型、分化程度和肿瘤的术后TNM分期等差异均无统计学意义(P>0.05),术后第一天疼痛评分、第三天疼痛评分研究组与对照组差异有统计学意义(t=-6.477,10.160;P<0.05)。研究组术后均未出现肠梗阻、腹腔出血、腹腔感染、吻合口漏、吻合口出血、吻合口狭窄、直肠切口出血、直肠切口漏等并发症,全组患者控粪功能未受明显影响。结论BMI指数在CRC-NOSES-Ⅷ式B法与腹腔镜辅助右半结肠癌根治术术式选择方面有重要价值和参考意义。在经选择适合入组的右半结肠癌患者行CRC-NOSES-Ⅷ式B法与传统腹腔镜辅助右半结肠癌根治术的近期疗效类似,手术技术安全可行,患者的疼痛感明显减轻。Objective To analyze the feasibility,safety and short-term efficacy of laparoscopic right colon cancer radical resection transrectal specimen extraction without abdominal incision.Methods The clinical data of laparoscopic right colon cancer radical resection transrectal specimen extraction without abdominal incision(CRC-NOSES-Ⅷtype B)and laparoscopy-assisted radical right hemicolectomy were collected from January 2018 to April 2021 in Cancer Hospital/Chinese Academy of Medical Sciences.Retrospectively analyze the influence of the two operation methods on postoperative recovery,complications and pathological results of patients.Results A total of 15 patients completed operation CRC-NOSES-Ⅷtype B,which was set as the experimental group.A total of 45 male patients with laparoscopic-assisted radical right hemicolectomy in the same period who met the inclusion criteria were randomly selected as the control group.There were no significant differences in gender,age,American Society of Anesthesiologists(ASA),laboratory examination,preoperative tumor size,location and clinical TNM stage between the experimental group and the control group(P>0.05).The difference in body mass index(BMI)between the experimental group and the control group was statistically significant(t=-2.401,P=0.022).All patients in the experimental group and control group completed the operation successfully,and no patients were transferred to open surgery.There were no significant differences in operative time,intraoperative blood loss,intestinal function recovery time,postoperative hospital stay,postoperative pathological tumor maximum diameter,lymph node detection and positive number,pathological type of tumor,degree of differentiation and postoperative TNM stage between the two groups(P>0.05).The pain scores on the first day and the third day after surgery were significantly different between the experimental group and the control group(t=-6.477,10.160;P<0.05).No postoperative complications such as intestinal obstruction,abdominal bleeding,abdomin

关 键 词：结肠肿瘤 腹腔镜 右半结肠癌 右半结肠癌根治术 经自然腔道取标本手术 经直肠切口 

分 类 号：R73[医药卫生—肿瘤]