腹部无切口类NOTES术在低位直肠癌患者中的应用疗效分析

Abdominal NOTES-like Procedure without Incision Applied in Low Rectal Carcinoma Patients：Effect Analysis

为了评估腹部无切口经肛门拖出标本类NOTES术在低位直肠癌患者中应用的可行性及临床疗效,将2013年10月至2016年11月于北京市仁和医院肛肠科行腹腔镜下低位直肠癌根治术治疗的30例患者分为类NOTES组和传统组.类NOTES组（10例）采用经肛门拖出标本类NOTES术,传统组（20例）采用传统腹腔镜低位直肠癌根治术.对比观察2组患者的临床疗效,分析类NOTES术的可行性及安全性.结果显示,2组患者术中标本环周、上、下切缘癌细胞残留均为阴性,2组患者手术时间、术中出血量、切口感染及术后住院时间差异无统计学意义（P〉0.05）.2组患者术后TNM分期,差异亦无统计学意义（P〉0.05）.2组患者术后1个月肛门功能Wexner评分差异无统计学意义（P〉0.05）;术后3个月Wexner评分,类NOTES组（8.7±0.8）分,高于传统组（7.7±1.3）分,P=0.03;术后6个月、12个月,2组患者Wexner评分差异无统计学意义（P〉0.05）.术后12个月2组患者肛门功能已基本正常.结果表明,经肛门标本拖出类NOTES术治疗低位直肠癌与传统腹腔镜手术疗效相当,该术式切实可行,近期疗效满意.

This study was to evaluate the feasibility and clinical efficacy of the abdominal natural orifice transluminal endoscopic surgery （NOTES） procedure without incision via anus pull-through specimen out in the radical surgery for low rectal carcinoma, divided 30 cases admitted and treated in authors＇ depart- ment （2013-10--2016-11） to be subject to laparoscopic radical surgery for their low rectal carcinoma into two groups：NOTES-like group （n= 10） and convention group （n= 20）; NOTES-like group performed NOTES-like procedure via anus pull-through specimen out on 10 cases, while convention group performed conventional laparoscopic radical surgery of low rectal carcinoma on 20 cases; then, compared both groups＇ effects, further analysed the feasibility and safety of NOTES-like procedure. As results, in both groups the circumferential, upper, lower cutting edge of intraoperative specimen showed cancer cells all remained negative~ in operative time, intraoperative bleeding volume, incision infection and postoperative hospital stay as well TNM stage there was no statistical difference between both groups （ P 〉0.05） ; as for Wexner score of postoperative anal function： at 1 month after surgery the score had no statistical difference （ P 〉 0.05） between two groups,at 3 months after surgery the score of NOTES-like group was higher than that of convention group [（8.7±0.8） points vs （7.7±1.3） points, P =0.03], at 6 months and at 12 months af- ter surgery there was no statistical difference between two groups （ P 〉0.05） ; at 12 months both groups＇ anal function had become normal basically. Results show that performing NOTES-like procedure via anus pull-through specimen out is same as conventional procedure in the effect of low rectal carcinoma, and is prac- tical feasible, having the satisfactory short-term efficacy.