免腹部辅助切口经自然腔道取标本完全腹腔镜下直肠癌根治术对第三间隙效应的影响

Influence of total laparoscopic resection for rectal cancer by natural orifice specimen extraction without abdominal auxiliary incision on the third space effect

目的探讨免腹部辅助切口经自然腔道取标本(NOSE)法完全腹腔镜下直肠癌根治术对第三间隙效应的影响。方法选取2016年1月至2018年6月在东南大学附属中大医院江北院区普外科住院并行根治性切除术的直肠癌患者120例,随机分为观察组与对照组,每组60例。对照组行常规腹腔镜直肠癌根治术,观察组行免腹部辅助切口NOSE法完全腹腔镜下直肠癌根治术,比较两组手术相关指标,分别于术前及术后24、48、72 h测定血清白蛋白(ALB)、前白蛋白(PAB)、总蛋白(TP)、Na^+、K^+、Ca^2+、一氧化氮(NO)、超氧化物歧化酶(SOD)、丙二醛(MDA)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)及白介素-6(IL-6)水平。结果两组患者的手术时间、淋巴结清扫数及术后并发症发生率比较差异均无统计学意义(P>0.05),但观察组的切口长度、术中出血量、术后首次排气时间、术后首次下床时间、术后住院时间均低于对照组,差异有统计学意义(P<0.05)。两组术后血清ALB、PAB、TP、Na^+、K^+、Ca^2+水平比较差异无统计学意义(P>0.05);观察组术后24、48、72 h的血清SOD水平高于对照组,血清MDA、CRP、TNF-α、IL-6水平低于对照组,差异均有统计学意义(P<0.05)。结论免腹部辅助切口NOSE法完全腹腔镜下直肠癌根治术安全可行,可减轻手术创伤及对第三间隙效应的影响,有利于术后康复。

Objective To investigate the influence of total laparoscopic resection for rectal cancer by natural orifice specimen extraction(NOSE)without abdominal auxiliary incision on the third space effect.Methods One hundred and twenty patients with rectal cancer were randomly divided into observation group and control group,with 60 cases in each group.The observation group underwent total laparoscopic resection by NOSE without abdominal auxiliary incision,the control group underwent routine laparoscopic radical resection.The surgical outcomes of the two groups were compared,the serum levels of albumin(ALB),prealbumin(PAB),total protein(TP),Na^+,K^+,Ca^2+,and nitric oxide(NO),superoxide dismutase(SOD),malondialdehyde(MDA),C-reactive protein(CRP),tumor necrosis factor alpha(TNF-α),and interleukin-6(IL-6)levels were measured before surgery and 24,48,72 h after surgery.Results There was no significant difference in the operation time,lymph node dissection and postoperative complication rate between the two groups(P>0.05),while the length of the incision,the amount of intraoperative blood loss,the first exhaust time after surgery,the time of first bed-out and postoperative hospital stay were significantly lower than those of the control group(P<0.05).There were no significant differences in serum levels of ALB,PAB,TP,Na^+,K^+ and Ca^2+ between the two groups(P>0.05).At 24,48,and 72 h after surgery,the serum level of SOD in the observation group was higher than that in the control group,while the serum levels of MDA,CRP,TNF-α,IL-6 were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusions The total laparoscopic resection for rectal cancer by NOSE without abdominal auxiliary incision is safe and feasible,which can reduce the impact of surgical trauma and the third space effect,and is conducive to postoperative rehabilitation.