79家医院718例结直肠肿瘤经自然腔道取标本手术回顾性研究

Retrospective study of 718 colorectal neoplasms treated by natural orifice specimen extraction surgery in 79 hospitals

目的通过收集国内79家医院开展的结直肠肿瘤经自然腔道取标本手术(NOSES)病例,阐述NOSES术在结直肠肿瘤中的应用现状及其可行性。方法本研究最终共纳入718例结直肠肿瘤NOSES病例,收集资料包括患者术前一般资料、手术相关资料、术后病理资料以及随访资料。结果患者一般资料显示:患者平均年龄为59.4±10.8岁,患者平均BMI指数为22.9±6.3 kg/m2,直肠NOSES术患者占总数的72.3%,有3.5%的患者接受了术前新辅助治疗;术后病理资料显示,I^IV期患者分别占31.3%,26.8%,30.8%,0.8%;中分化腺癌比例占病例总数的62.1%,肿瘤最大直径平均为4.1±1.8 cm,淋巴结检出数目平均为13.4±3.5枚。本研究中76.2%的患者行腹腔镜直肠前切除术联合经自然腔道取标本手术;90.4%的患者采用经直肠取标本,经阴道取标本病例占9.6%;NOSES手术时间平均为210.5±39.4分钟,术中出血量平均为61.8±23.1 ml,术后排气时间平均为44.5±10.3小时,术后进食时间平均为64.9±14.6小时,术后住院时间为12.1±4.0天,并发症发生率为10.6%,术后肛门功能障碍者占总数的1.5%,未发现阴道功能障碍者。结论结直肠肿瘤NOSES术在我国广泛开展,且表现出巨大的推广潜力。同时,NOSES术符合肿瘤根治术要求,并具有良好的近期疗效,因此该技术是一种安全可靠的微创外科技术。

Objective To study the application status and feasibility of natural orifice specimen extraction surgery(NOSES)in colorectal neoplasms by collecting the NOSES cases in79hospitals around China.Methods A total of718cases of NOSES were collected.The data of patients included demographic data,surgical data,postoperative pathology and follow-up data.Results The average age of patients was59.4±10.8years,the average BMI is22.9±6.3kg/m2,72.3%of patients received rectal NOSES,and3.5%of patients received neoadjuvant therapy.Pathological results showed that patients in stage I^IV were31.3%,26.8%,30.8%and0.8%respectively.The proportion of adenocarcinoma was62.1%,the average diameter of tumor was4.1±1.8cm,and the number of lymph nodes was13.4±3.5.In this study,76.2%of patients underwent laparoscopic anterior resection combined with NOSES.90.4%of the patients were treated with rectal specimen extractions and9.6%by vaginal extractions.The average operation time was210.5±39.4minutes,the average blood loss was61.8±23.1ml,the average postoperative exhaust time was44.5±10.3hours,and the time of postoperative feeding time was64.9±14.6hours,the average of postoperative hospital stay was12.1±4.0days,the incidence of complications was10.6%,postoperative anal dysfunction accounted for1.5%of the total,no vaginal dysfunction was detected.Conclusion NOSES in colorectal neoplasms is widely carried out in China and has shown great potential for promotion.At the same time,NOSES surgery followed the requirement of tumor radical surgery,presenting with good short-term effect.Therefore,this technology is a safe and reliable minimally invasive surgery.