51例结直肠癌经自然腔道取标本手术患者的临床资料分析  

Analysis the clinical data from 51 colorectal cancer patients undergoing natural or⁃ifice specimen extraction surgery

作　　者：罗军 王刚[1,2] 刘勇[1,2] 朱玉萍[1,2] 冯海洋[1,2] Luo Jun;Wang gang;Liu yong;Zhu Yuping;Feng Haiyang(Department of Colorectal Surgery,Zhejiang Cancer Hospital,Hangzhou 310022,Zhejiang,China;Hangzhou Institute of Medical Research,Chinese Academy of Sciences,Hangzhou 310018,Zhejiang,China)

机构地区：[1]浙江省肿瘤医院结直肠外科,浙江杭州310022 [2]中国科学院杭州医学研究所,浙江杭州310018

出　　处：《结直肠肛门外科》2023年第5期449-454,共6页Journal of Colorectal & Anal Surgery

基　　金：浙江省医药卫生科技项目(2022KY083、2021KY588);浙江省基础公益研究计划项目(LTGD22C040016、LTGD23H030001)。

摘　　要：目的 分析结直肠癌经自然腔道取标本手术(NOSES)的患者的临床资料,探讨NOSES的安全性和肿瘤学预后。方法回顾性分析2017年1月至2023年7月浙江省肿瘤医院收治的51例接受NOSES的结直肠癌患者的临床资料,分析手术相关指标、术后并发症情况、术后病理结果和术后随访情况,并进行生存分析。结果 51例患者中,术中出血量<100 mL34例(66.7%),术中出血量≥100 mL17例(33.3%);手术时间(185.5±74.3) min;淋巴结获取数量(16.8±7.7)枚;肿瘤距肛缘距离<5 cm 36例(70.6%),肿瘤距肛缘距离≥5 cm 15例(29.4%);病灶直径<5 cm 46例(90.2%),病灶直径≥5 cm 5例(9.8%);NOSES术式为外翻切除式11例(21.6%),拖出切除式23例(45.1%),切除拖出式17例(33.3%);经直肠取出标本46例(90.2%),经阴道取出标本5例(9.8%);术中行回肠保护性造口术7例(13.7%);术后肛门首次排气时间3(3,7)d,术后首次进食半流质饮食时间7(5,8)d,术后住院时间10(8,11)d。术后发生吻合口漏1例(2%),保守治疗后愈合良好;吻合口出血1例(2%);肠梗阻2例(3.9%),均为不完全性肠梗阻,保守治疗后病情缓解;腹盆腔感染3例(5.9%),尿路感染1例(2%),无腹盆腔出血、脓毒血症、肺部感染和非计划二次手术。术后病理T分期,T_0期3例、T_1期9例、T_2期17例、T_3期11例、T_4期11例;N分期,N0期39例、N1期11例、N2期1例;TNM分期,0期3例、Ⅰ期20例、Ⅱ期15例、Ⅲ期11例、Ⅳ期2例;分化程度,中高分化45例,低分化、未分化6例;2例有癌结节;11例有脉管侵犯;7例有神经侵犯。随访截至2023年8月,中位随访时间58 (1,76)个月,无失访患者。随访期间3例患者发生复发转移(其中2例术前已发生远处转移,同期行根治性手术,分别于术后12个月、24个月出现肝脏复发;另1例术后病理TNM分期为Ⅱa期,存在脉管神经侵犯,术后27个月出现肺部复发),1例患者死亡(该患者术前已发生远处转移,同期切除原发灶和转移灶)。对所有患者进�Objectives To analyze the clinical data from colorectal cancer patients undergoing natural orifice specimen extraction surgery(NOSES)and explore the safety and oncological prognosis of NOSES.Methods A retrospective analysis was conducted on the clinical data of 51 patients with colorectal cancer who underwent NOSES at Zhejiang Cancer Hospital from January 2017 to July 2023.Surgical-related indicators,postoperative complications,pathological results and follow-up were analyzed,with survival analysis performed.Results Among the 51 patients,intraoperative blood loss was less than 100 mL in 34 patients(66.7%)and more than or equal to 100 mL in 17 patients(33.3%).The operation time averaged(185.5±74.3)minutes,and the mean number of lymph nodes obtained was(16.8±7.7).The tumor-to-anal margin distance was less than 5 cm in 36 patients(70.6%)and more than or equal to 5 cm in 15 patients(29.4%).Lesion diameter was less than 5 cm in 46 patients(90.2%)and more than or equal to 5 cm in 5 patients(9.8%).NOSES surgical methods included external excision in 11 patients(21.6%),pull-out excision in 23 patients(45.1%),and resection and traction in 17 patients(33.3%).Specimens were extracted from the rectum in 46 patients(90.2%)and through the vagina in 5 patients(9.8%).Protective colostomy was performed during the operation in 7 patients(13.7%).Postoperative recovery times were as follows:time to first flatus after surgery was 3(3,7)days,time to eat a semi-liquid diet after surgery was 7(5,8)days,and hospitalization time after surgery was 10(8,11)days.Postoperative complications included anastomotic leakage in 1 patient(2%),which healed well after conservative treatment;postoperative anastomotic bleeding in 1 patient(2%);and intestinal obstruction in 2 patients(3.9%),all of which were incomplete intestinal obstruction and improved after conservative treatment.Abdominal and pelvic infection occured in 3 patients(5.9%),urinary tract infection in 1 patient(2%),with no instances of abdominal and pelvic bleeding,bacteremia,pulmonary

关 键 词：结直肠癌 经自然腔道取标本手术 微创手术 安全性 肿瘤学预后 

分 类 号：R735.3[医药卫生—肿瘤]