结直肠癌NOSES和传统腹腔镜手术的临床对比研究和探讨

Clinical comparative study and discussion between NOSES surgery and traditional laparoscopic surgery for colorectal cancer

目的近年来在微创理论的指引下外科手术朝向不断追求更小的切口和创伤的方向发展,相对于传统腹腔镜手术,结直肠癌经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)更加体现了微创的优势,但它的安全性和可行性仍需要更广泛地研究和讨论。方法回顾性的收集了2019年3~6月在中国医科大学附属一院肿瘤外科接受传统腹腔镜(传统腹腔镜手术组)或NOSES(NOSES组)的30例结直肠癌患者的数据,使用t检验和Fisher确切概率法,分析接受这两种不同术式的患者在术中和术后相关指标的差异。结果在术中指标方面,两组患者在术中出血量(P=0.639)和淋巴结清扫数量(P=0.524)方面没有统计学差异;而在平均手术时间方面呈现出统计学差异,平均手术时间NOSES组(228.1±69.58)min、传统腹腔镜手术组(160.25±48.83)min(P=0.004);在术后近期预后方面,两组间术后并发症发生率均无统计学差异,术后发热(P=0.584)、腹泻(P=0.657)、胰腺炎(P=1.000)、淋巴管漏(P=0.540)、术后肠梗阻(P=0.532)、术后出血量(P=1.000)和心功能失常(P=1.000)。在术后住院情况方面,两组间也无统计学差异,包括术后排气时间(P=0.418)、平均术后住院时间(P=0.593)、平均住院总花费(P=0.848)、术后30 d再住院率(P=0.333)。结论结直肠癌NOSES在安全性、有效性等方面同传统结直肠癌腹腔镜手术相比没有统计学差异,且能避免患者腹壁切口和术后瘢痕等问题。结直肠癌NOSES值得进一步研究和推广。

Objective In recent years,guided by the theory of minimally invasive surgery,the NOSES operation for colorectal cancer has demonstrated the advantages of minimally invasive surgery compared with traditional laparoscopy surgery,but its safety and feasibility still need to be studied and discussed more widely.Methods The data of 30 patients with colorectal cancer who underwent conventional laparoscopic or NOSES surgery from Mar.to Jun.2019 at the China Medical University has been collected,retrospectively.T test and Fisher′s exact test were used in the study.The differences of intraoperative and postoperative parameters between patients undergoing two different surgical procedures were analyzed.Results The data showed that there was no significant difference in the amount of blood loss(P=0.639)and the number of lymph node dissection(P=0.524)between the two groups,but there was significant difference in the average operation time(P=0.004).The average operation time was(228.1±69.58)min in the NOSES group and(160.25±48.83)min in the conventional laparoscopic group(P=0.004).In terms of short-term prognosis,there was no significant difference in the incidence of postoperative complications between the two groups,including postoperative fever(P=0.584),diarrhea(P=0.657),pancreatitis(P=1.000),lymphatic leakage(P=0.540),intestinal obstruction(P=0.532),bleeding(P=1.000)and cardiac insufficiency(P=1.000).There was no significant difference in data between the two groups in terms of postoperative hospitalization,such as postoperative exhaust time(P=0.418),average length of stay(P=0.593),average total cost(P=0.848)and rehospitalization rate(P=0.333).Conclusions The retrospective data suggested that NOSES operation for colorectal cancer has no significant difference in safety and efficacy compared with conventional laparoscopic surgery,what’s more,the NOSES operation can avoid abdominal wall incision and postoperative scarring.NOSES operation for colorectal cancer is worthy of further study and promotion.