直肠癌腹腔镜前切除术经自然腔道标本取出的危险因素分析  

Risk factor analysis of laparoscopic anterior resection for rectal cancer via natural cavity specimen extraction

作　　者：岳德亮 王道岭 刘宇 YUE Deliang;WANG Daoling;LIU Yu(Department of General Surgery,Xinyang Central Hospital,Xinyang,Henan 464000,China)

机构地区：[1]信阳市中心医院普通外科,河南信阳464000

出　　处：《安徽医药》2023年第2期374-377,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨直肠癌腹腔镜前切除术经自然腔道取出标本手术(NOSES)的危险因素。方法回顾性分析信阳市中心医院2016年1月至2018年6月收治直肠癌病人104例,均尝试在直肠前切除术中经自然腔道取出标本,采用单因素和多因素法寻找经自然腔道标本取出的独立影响因素。结果104例病人术中经自然腔道标本取出成功共33例;单因素分析结果显示,体质量指数(BMI)、肿瘤梗阻有无、肿瘤距肛缘长度、肿瘤长径及直肠系膜前后径与直肠癌病人经自然腔道标本取出结局有关(P<0.05);多因素分析结果显示,BMI≤25 kg/m^(2)、无肿瘤梗阻、肿瘤距肛缘长度<5 cm、肿瘤长径≤5 cm及直肠系膜前后径≤6 cm均是直肠癌病人经自然腔道标本取出结局独立保护因素(P<0.05)。结论直肠癌病人直肠前切除术中经自然腔道标本取出结局与BMI、肿瘤梗阻有无、肿瘤距肛缘长度、肿瘤长径及直肠系膜前后径独立相关;术前应综合评估病人相关临床因素以筛选出NOSES手术合适人群。Objective To investigate the risk factors for natural cavity specimen extraction surgery(NOSES) via laparoscopic anterior resection for rectal cancer.Methods A retrospective analysis of 104 patients with rectal cancer admitted to Xinyang Central Hospital from January 2016 to June 2018 was performed to retrieve specimens via the natural cavity during anterior resection, and univariate and multivariate methods were used to explore the independent influencing factors on the retrieval of specimens via natural cavity.Results A total of 33 patients were successfully removed intraoperatively via the natural cavity specimens in 104 patients. Univariate analysis showed that body mass index(BMI),presence of tumor obstruction, length of tumor from anal margin, maximum tumor diameter and anteroposterior mesenteric diameter were related to the outcome of patients with rectal cancer via natural cavity specimen extraction(P<0.05). Multivariate analysis showed that BMI≤25 kg/m2,absence of tumor obstruction, length of tumor from anal margin < 5 cm,maximum tumor diameter ≤ 5 cm and anteroposterior mesenteric diameter ≤ 6 cm were all independent protective factors for the outcome of rectal cancer patients via natural cavity specimen extraction(P<0.05).Conclusions The outcome of natural cavity specimen extraction was independently correlated with BMI, tumor obstruction, length of tumor from the anal margin, maximum tumor diameter and anterior and posterior rectal mesenteric diameter in patients with rectal cancer. A comprehensive evaluation of patient-related clinical factors should be performed preoperatively to screen the appropriate population for NOSES surgery..

关 键 词：直肠肿瘤 经自然腔道手术 腹腔镜 影响因素 

分 类 号：R735.37[医药卫生—肿瘤]