经自然腔道取标本的腹腔镜手术与腹腔镜辅助手术在直肠癌根治术中的近期疗效比较  

Comparison of short-term efficacy between laparoscopic surgery with natural orifice specimen extraction and laparoscopic-assisted surgery for radical resection of rectal cancer

作　　者：李小鹏 李静[1,2] 王炜 牟明超[1] 赵晨野 陈子璐 余钧辉 霍雄伟[1] 孙学军[1] LI Xiaopeng;LI Jing;WANG Wei;MU Mingchao;ZHAO Chenye;CHEN Zilu;YU Junhui;HUO Xiongwei;SUN Xuejun(Department of General Surgery,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of General Surgery,Xi’an XD Group Hospital,Xi’an 710077,China)

机构地区：[1]西安交通大学第一附属医院普通外科,陕西西安710061 [2]西电集团医院普通外科,陕西西安710077

出　　处：《西安交通大学学报（医学版）》2023年第6期990-995,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金面上项目(No.81972720)。

摘　　要：目的通过比较经自然腔道取标本(NOSE)的腹腔镜直肠癌根治术与腹腔镜辅助直肠癌根治术的术后病理资料、手术相关情况及术后恢复情况,探讨NOSE的腹腔镜直肠癌根治术的可行性、安全性及临床应用价值。方法回顾性分析2017年7月至2022年4月于西安交通大学第一附属医院普通外科行保肛的直肠癌根治手术患者74例。其中经腹部辅助切口取标本手术(辅助切口组)38例,经自然腔道取标本手术(NOSES组)36例,通过比较两组患者术后病理资料、手术相关情况及术后恢复情况,从而比较两种手术疗效的差异。结果两组直肠癌患者一般资料及术后病理资料差异均无统计学意义(P均>0.05)。与辅助切口组相比,NOSES组患者手术时间、术后首次排气时间、术后首次进流食时间及术后住院时间均明显缩短(P均<0.05),而在术中出血量、术后并发症及是否二次手术方面差异均无统计学意义(P均>0.05)。结论NOSE的腹腔镜手术在直肠癌是安全可行的,具有微创、加速康复的特点,值得在临床推广应用。Objective To explore the feasibility,safety and clinical application value of laparoscopic radical rectal cancer surgery with natural orifice specimen extraction(NOSE)by comparing the postoperative pathological data,surgery-related variables and postoperative recovery between laparoscopic radical rectal cancer surgery with NOSE and laparoscopic-assisted radical rectal cancer surgery.Methods A retrospective analysis was conducted on 74 patients who underwent radical rectal cancer surgery with anus preservation in the Department of General Surgery of The First Affiliated Hospital of Xi’an Jiaotong University from July 2017 to April 2022.Among them,38 cases underwent surgery with specimen extraction through an abdominal auxiliary incision(auxiliary incision group),and 36 cases underwent surgery with specimen extraction through a natural orifice(NOSES group).The differences in the efficacy of the two surgeries were evaluated by comparing the postoperative pathological data,surgical variables,and postoperative recovery of the two groups.Results There were no statistically significant differences in general data and postoperative pathological data between the two groups(all P>0.05).The NOSES group exhibited significantly shorter operative time,time to first flatus,time to first oral intake postoperatively,and postoperative hospital stay compared to the auxiliary incision group(all P<0.05).However,there were no statistically significant differences in intraoperative blood loss,postoperative complications,and whether secondary surgeries were performed(all P>0.05).Conclusion Laparoscopic surgery with NOSE for rectal cancer is safe and feasible with minimally invasive and accelerated recovery,which is worth promoting and applying in clinical practice.

关 键 词：直肠癌 经自然腔道取标本(NOSE) 经自然腔道取标本手术(NOSES) 辅助切口 腹腔镜手术 

分 类 号：R735.3[医药卫生—肿瘤]