蔡氏套管器在胃肠道经自然腔道取标本手术中的应用:234例临床分析  

Specimen extraction through natural orifices with Cai tubes in gastrointestinal surgery:a single-institute series of 234 cases

作　　者：庄伊凡 许淑镇 王振发[1] 丁志杰[1] 张诗峰[1] 闫峰[1] 蔡建春[1] Zhuang Yifan;Xu Shuzhen;Wang Zhenfa;Ding Zhijie;Zhang Shifeng;Yan Feng;Cai Jianchun(Department of Gastrointestinal Surgery,Gastrointestinal Tumor Institute of Xiamen University School of Medicine,Xiamen Key Laboratory of Gastrointestinal Tumor,Zhongshan Hospital,Xiamen University,Xiamen 361004,China)

机构地区：[1]厦门大学附属中山医院胃肠外科、厦门大学医学院胃肠肿瘤研究所、厦门市胃肠肿瘤重点实验室,厦门361004

出　　处：《中华胃肠外科杂志》2023年第4期357-364,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：福建省科技计划引导性项目(2015D008);福建省卫生系统中青年人才骨干培养项目(2015-ZQN-JC-42);厦门市医疗卫生指导性项目(3502Z20199171);厦门市医疗卫生重点项目(3502Z20204002)。

摘　　要：目的探讨蔡氏套管器在胃肠道经自然腔道取标本手术(NOSES)中的应用价值。方法本研究采用描述性病例系列研究的方法。病例纳入标准:(1)经术前病理检查确诊为结直肠癌或胃癌,或术前钡灌肠造影提示乙状结肠冗长或横结肠冗长;(2)具备传统腹腔镜手术的适应证;(3)体质指数<30 kg/m^(2)(经肛门手术)和35 kg/m^(2)(经阴道手术);(4)女性患者经阴道取标本者无阴道狭窄或粘连;(5)结肠冗长症患者年龄为18~70岁,具有顽固性便秘病史且病程10年以上者。排除标准:(1)合并肠穿孔、梗阻的结直肠癌,或合并胃穿孔、胃出血、幽门梗阻的胃癌;(2)合并肺、骨远处转移或无法同期切除的肝转移;(3)有腹部大手术史或存在肠粘连;(4)临床资料不完整者。按照上述标准,2014年1月至2022年10月期间,厦门大学附属中山医院胃肠外科应用蔡氏套管器行NOSES手术共治疗209例胃肠肿瘤和25例结肠冗长症患者,其中中低位直肠癌14例,行外翻拖出式NOSES直肠癌根治术;左结直肠癌171例,行NOSES左半结肠癌根治术;右结肠癌12例,行NOSES右半结肠癌根治术;胃癌12例,行NOSES系统性胃系膜切除术;结肠冗长症25例,行NOSES结肠次全切除术。均采用自制免辅助切口肛门套管器——蔡氏套管器(中国发明专利号:ZL201410168748.2)取标本。主要观察指标为术后1年无复发生存率和并发症发生情况。结果全组234例患者中,男性116例,女性118例;年龄(56.6±10.9)岁。所有患者均顺利施行NOSES手术,无中转开腹者,无手术相关死亡者。术后环周切缘阴性率为98.8%(169/171),仅2例阳性,均为左结直肠癌组患者。术后37例(15.8%)患者出现并发症,其中出现吻合口漏11例(4.7%),吻合口出血3例(1.3%),腹腔内出血2例(0.9%),腹腔感染4例(1.7%),肺部感染8例(3.4%)。术后再手术7例(3.0%),均为吻合口漏后行回肠造口术。术后30 d内总再入院率为0.9%(2/234)。随访(18.3±3.6)个月,Objective To investigate the feasibility of Cai tube-assisted natural orifice specimen extraction surgery(NOSES)in gastrointestinal surgery.Methods This was a descriptive case-series study.Inclusion criteria:(1)colorectal or gastric cancer diagnosed by preoperative pathological examination or redundant sigmoid or transverse colon detected by barium enema;(2)indications for laparoscopic surgery;(3)body mass index<30 kg/m^(2)(transanal surgery)and 35 kg/m^(2)(transvaginal surgery);(4)no vaginal stenosis or adhesions in female patients undergoing transvaginal specimen extraction;and(5)patients with redundant colon aged 18–70 years and a history of intractable constipation for more than 10 years.Exclusion criteria:(1)colorectal cancer with intestinal perforation or obstruction,or gastric cancer with gastric perforation,gastric hemorrhage,or pyloric obstruction;(2)simultaneous resection of lung,bone,or liver metastases;(3)history of major abdominal surgery or intestinal adhesions;and(4)incomplete clinical data.From January 2014 to October 2022,209 patients with gastrointestinal tumors and 25 with redundant colons who met the above criteria were treated by NOSES utilizing a Cai tube(China invention patent number:ZL201410168748.2)in the Department of Gastrointestinal Surgery,Zhongshan Hospital,Xiamen University.The procedures included eversion and pull-out NOSES radical resection in 14 patients with middle and low rectal cancer,NOSES radical left hemicolectomy in 171 patients with left-sided colorectal cancer,NOSES radical right hemicolectomy in 12 patients with right-sided colon cancer,NOSES systematic mesogastric resection in 12 patients with gastric cancer,and NOSES subtotal colectomy in 25 patients with redundant colons.All specimens were collected by using an in-house-made anal cannula(Cai tube)with no auxiliary incisions.The primary outcomes included 1-year recurrence-free survival(RFS)and postoperative complications.Results Among 234 patients,116 were male and 118 were female.The mean age was(56.6±10.9)years.N

关 键 词：胃肿瘤 结直肠肿瘤 结肠冗长症 胃肠外科 经自然腔道取标本手术 蔡氏套管器 

分 类 号：R656[医药卫生—外科学]