结直肠癌经自然腔道取标本手术的早期炎性反应、肿瘤学治疗结局与远期预后  

Early inflammatory response,oncological outcomes and long-term prognosis of natural orifice specimen extraction surgery for colorectal cancer

作　　者：刘远[1] 周晓蕾 李国雷[1] 李伟 徐志峰[1] 李新宇 徐曌 兴伟[1] LIU Yuan;ZHOU Xiaolei;LI Guolei;LI Wei;XU Zhifeng;LI Xinyu;XU Zhao;XING Wei(Department of General Surgery,the National TCM Clinical Research Base/Hebei Province Hospital of Chinese Medicine,Hebei Shijiazhuang 050000,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;Department of General Surgery,Luanzhou People's Hospital,Hebei Luanzhou 063700,China)

机构地区：[1]国家中医临床研究基地/河北省中医院外一科,河北石家庄050000 [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 [3]滦州市人民医院普外科,河北滦州063700

出　　处：《现代肿瘤医学》2024年第13期2380-2386,共7页Journal of Modern Oncology

基　　金：中国癌症基金会北京希望马拉松专项基金(编号:LC2019A30)。

摘　　要：目的:比较结直肠癌传统腹腔镜手术(laparoscopic surgery,LAP)与无腹部辅助切口是经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)术后的炎性反应程度、肿瘤学治疗结局与远期生存预后。方法:共1 020例患者纳入研究,其中NOSES组416例,LAP组604例。倾向得分匹配平衡两组患者基线资料,最后,两组各有344例患者纳入研究。收集两组患者临床病理特征、围手术期参数、早期炎性反应指标与预后信息。研究终点为5年总生存期(overall survival,OS)、无瘤生存率(disease-free survival,DFS)与无局部复发率生存率(local-recurrence free survival,LRFS)。结果:NOSES具有术后疼痛轻(P<0.05)、额外麻醉药物使用比例少(11.0%vs 29.9%,P<0.001)、切口并发症发生率低(1.5%vs 4.4%,P=0.023)、术后胃肠道功能恢复快(2.7 vs 3.3天,P=0.022)等短期优势。NOSES组患者术后第2天平均体温显著高于LAP组(37.3 vs 37.1℃,P=0.031)。此外,NOSES组患者术后第1、3天的平均中性粒细胞百分比与术后第3天的C反应蛋白水平显著高于LAP组(P<0.05)。然而,两组患者术后盆腔感染并发症发生率无显著差异(0.9%vs 1.2%,P=1.000)。此外,两组患者标本长度、近端切缘距肿瘤距离、远端切缘距肿瘤距离和淋巴结清扫数量等病理结果方面无统计学差异(P>0.05)。预后方面,两组患者有着相似的5年OS(91.6%vs 89.3%,P=0.434)、DFS(84.1%vs 83.6%,P=0.898)与LRFS(95.9%vs 94.0%,P=0.369)。结论:结直肠癌NOSES是安全可行的,有着疼痛轻、恢复快、切口并发症发生率低等明显的短期优势。虽然NOSES手术会在早期引起较强的急性全身炎性反应,然而并不会转化为相关并发症。此外,NOSES手术与LAP有着相似的肿瘤学治疗结局与远期预后,可以在临床工作中广泛开展与推广。Objective:To compare the inflammatory response,oncological outcomes,and long-term survival prognosis between conventional laparoscopic surgery(LAP) and natural orifice specimen extraction surgery(NOSES) for colorectal cancer.Methods:A total of 1 020 patients were included,including 416 patients in NOSES group and 604 patients in LAP group.Propensity score matching was used to balance baseline data between the two groups.Finally,344 patients were enrolled in each group.Clinicopathological features,perioperative parameters,early inflammatory response indicators and prognostic information of the two groups were collected.The endpoints of this study were 5-year overall survival(OS),disease-free survival(DFS),and local-recurrence free survival(LRFS).Results:NOSES had short-term advantages such as mild postoperative pain(P < 0.05),low proportion of additional anesthetic drugs used(11.0% vs 29.9%,P < 0.001),low incidence of incision infection(1.5% vs 4.4%,P = 0.023),and rapid recovery of gastrointestinal function after surgery(2.7 vs 3.3 days,P = 0.022).The mean body temperature on the second day after surgery in the NOSES group was significantly higher than that in the LAP group(37.3 vs 37.1 ℃,P =0.031).In addition,the mean percent of neutrophile granulocyte on day 1 and day 3 after surgeryand C-reactive protein levels on day 3 after surgery in the NOSES group were significantly higher than those in the LAP group(P < 0.05).However,there was no significant difference in the incidence of postoperative pelvic infection between the two groups(0.9% vs 1.2%,P = 1.000).In addition,there were no significant differences in pathological outcomes such as specimen length,distance from proximal margin to tumor,distance from distal margin to tumor,and number of lymph node dissection between the two groups(P > 0.05).In terms of prognosis,the two groups had similar five-year OS(91.6% vs 89.3%,P = 0.434),DFS(84.1% vs 83.6%,P = 0.898),and LRFS(95.9% vs 94.0%,P = 0.369).Conclusion:NOSES for colorectal cancer is safe and feasible,with o

关 键 词：结直肠癌 经自然腔道取标本手术 炎性反应 预后 局部复发 

分 类 号：R735.3[医药卫生—肿瘤]