经自然腔道取出标本手术联合加速康复外科理念在乙状结肠及直肠癌中的应用

Clinical Study on the Treatment of Sigmoid Colon and Rectal Cancer by Transluminal Resection Combined with Accelerated Rehabilitation Surgery

目的探讨经自然腔道取出标本(NOSE)手术联合加速康复理念(ERAS)在乙状结肠及直肠癌治疗中的应用效果。方法选择我院2016年12月—2017年10月期间收治的乙状结肠及直肠癌患者90例,随机数字表法分为腹腔镜手术加传统护理组、腹腔镜手术加ERAS组和NOSE手术加ERAS组,每组30例。腹腔镜手术加传统护理组给予腹腔镜手术联合常规护理干预,腹腔镜手术加ERAS组患者给予腹腔镜手术联合ERAS干预,NOSE手术加ERAS组患者给予NOSE手术联合ERAS干预,比较三组应用情况。结果三组在术后首次排气时间、首次排便时间、住院时间上比较,差异有统计学意义,NOSE手术加ERAS组比腹腔镜手术加ERAS组明显更低,腹腔镜手术加ERAS组低于腹腔镜手术加传统护理组(P <0. 05); NOSE手术加ERAS组切口感染发生率显著低于腹腔镜手术加传统护理组和腹腔镜手术加ERAS组,NOSE手术加ERAS组和腹腔镜手术加ERAS组的恶心呕吐、尿路感染、肺部感染发生率显著低于腹腔镜手术加传统护理组,三组在术后并发症发生率上差异有统计学意义(P <0. 05);三组在疼痛程度上比较差异有统计学意义,NOSE手术加ERAS组疼痛程度明显轻于腹腔镜手术加ERAS组,腹腔镜手术加ERAS组轻于腹腔镜手术加传统护理组(P <0. 05)。结论在乙状结肠及直肠癌治疗中采用经自然腔道取出标本手术联合加速康复理念手术效果、安全性及术后疼痛程度方面均有明显优势,是治疗乙状结肠及直肠癌的理想手段。

Objective To investigate the effect of NOSE combined with ERAS in the treatment of sigmoid and rectal cancer. Methods 90 patients with sigmoid colon and rectal cancer were randomly divided into three groups： laparoscopic surgery plus traditional nursing group, laparoscopic surgery plus ERAS group and NOSE operation plus ERAS group, with 30 cases in each group. Laparoscopic surgery plus traditional nursing group was given laparoscopic surgery combined with routine nursing intervention, laparoscopic surgery plus ERAS group was given laparoscopic surgery combined with ERAS intervention, NOSE surgery plus ERAS group was given NOSE surgery combined with ERAS intervention, the application of the three groups were compared. Results The first exhaust time, first defecation time and hospitalization time of the three groups were significantly lower in the NOSE plus ERAS group than in the laparoscopic plus ERAS group. The incision infection rate in the NOSE plus ERAS group was lower than that in the laparoscopic plus ERAS group （ P 〈 0. 05 ）. The incidence of nause- a, vomiting, urinary tract infection and pulmonary infection in NOSE plus ERAS group and laparoscopic plus ERAS group were significantly lower than those in laparoscopic plus traditional nursing group （ P 〈 0. 05 ） There was significant difference in the degree of pain among the three groups. The degree of pain in NOSE plus ERAS group was significantly lighter than that in laparoscopic plus ERAS group, and that in laparoscopic plus ERAS group was lighter than that in laparoscopic plus traditional nursing group （ P 〈 0. 05 ）. Conclusion It is an ideal method for the treatment of sigmoid and rectal cancer to take out specimens through natural cavity combined with accelerated rehabilitation in terms of the effect, safety and postoperative pain.