腹腔镜下结直肠癌体内切除标本经直肠拖出手术(NOSES)的无菌和无瘤操作技巧

Aseptic and tumor-free operation skills of laparoscopic resection of colorectal cancer with specimen body-inside resection and dragging-out removal via natural orifice

目的探讨腹腔镜下结直肠癌自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)标本体内切除经直肠拖出手术的无菌和无瘤操作技巧及近期疗效分析。方法回顾性分析四川省肿瘤医院2017年6月至2018年11月采用标本体内切除后经直肠拖出方式行腹腔镜结直肠癌NOSES的26例患者临床资料,分析手术时间、术中出血量、术中污染、术后胃肠功能、并发症、住院时间及肿瘤复发转移等情况。结果 26例患者均顺利完成手术,平均手术时间240. 4 min(150～330 min),平均术中出血量56. 9 ml(20～100 ml),平均术后排气时间21. 3 h(8～48 h),平均住院时间10. 0 d(7～15 d),术后无并发症发生;随访至2018年11月,无一例发现复发或转移。结论腹腔镜下结直肠癌NOSES标本体内切除拖出手术安全可行,创伤小、恢复快;只要术中严格遵守无菌和无瘤原则,掌握关键操作技巧,可以有效降低甚至避免腹腔污染和肿瘤医源性扩散风险。

Objective To discuss the aseptic and tumor-free skills and to investigate the short-term effects of laparoscopic natural orifice specimen extraction surgery( NOSES) for colorectal cancer by means of body-inside resection and dragging-out removal. Methods The clinical data of 26 patients with colorectal cancer who underwent laparoscopic NOSES operation by means of body-inside resection and dragging-out removal via rectum from Jun. 2017 to Nov. 2018 in Sichuan cancer hospital were retrospectively analyzed,including the operation duration, intraoperative bleeding, intraperitoneal contamination, postoperative exhausting time,postoperative complications,hospital stay,and status of tumor recurrence and metastasis.Results All operations of 26 patients were completed successfully,with average operative time 240. 4 minutes( 150-330 minutes),intraoperative bleeding 56. 9 ml( 20-100 ml),postoperative exhausting time 21. 3 hours( 8-48 hours),and average hospital stay 10. 0 days( 7-15 days). No postoperative complications were observed,and no recurrence or metastasis has been found up to now. Conclusions Laparoscopic colorectal NOSES operation by means of body-inside resection and dragging-out removal is safe and feasible,with advantages of minimally invasion and fast recovery. As long as the principle of asepsis and tumor-free is strictly observed and the key manipulation skills are proficiently mastered, the risk of intraperitoneal contamination and iatrogenic spread of tumors can be effectively avoided.