联合两种微创术式治疗直肠癌的临床疗效研究

Clinical study of combined minimally invasive surgical treatments for rectal cancer

目的评估腹腔镜下直肠癌切除术(LCRs)后进行经自然腔道标本取出术(NOSE)的患者的成功率和影响因素。方法回顾性分析2016年4月至2018年4月76例直肠癌患者LCRs之后尝试进行NOSE的资料。肛门入路作为第一选择,当此入路失败时,女性患者可尝试经阴道入路。如果两种入路都失败,则判定该患者不适合接受NOSE,并通过腹壁切口取出。记录手术指征,切除位置,实施程序,切口部位,吸引方法,标本大小和NOSE失败病例。采用SPSS18. 0软件对数据进行统计分析,NOSE成功与失败病例χ2检验;标本大小采用t检验。P <0. 05差异有统计学意义。结果 7例患者需要在手术切除时转为腹壁开放切口手术。在剩下的69例患者中,51例(73. 9%)成功完成LCRs后的NOSE,18例(26. 1%)失败。患者的标本经肛门和经阴道入路提取的数量分别是48例(94. 1%)和3例(5. 9%)。LCRs后,结肠病变严重和肿瘤体积大的男性患者NOSE成功率较低。经肛门和经阴道切除标本的平均大小分别为(3. 6±3. 2)和(5. 6±1. 5) cm,失败病例的平均肿瘤大小为(6. 6±4. 4) cm,(P <0. 05)。结论直肠癌患者在腹腔镜下直肠癌切除术后行经自然腔道标本取出术效果更好,较轻微的病变和女性患者具有较高的成功率。

Objective To investigate success rate and influential factors of laparoscopic colorectal resections(LCRs)followed by natural orifice specimen extraction(NOSE)in patients with rectal cancer.Methods From April 2016 to April 2018,retrospective analysis were performed in 76 patients with rectal cancer who received LCRs+NOSE.We prefer to anal approach firstly,however if it fails,vaginal approach would be tried.If both approaches fail,the patient would be judged to be unsuitable for NOSE,then specimen would be removed through abdominal incision.Surgical indications,location of excision,procedure,incision site,method of aspiration,specimen size,and NOSE failure were recorded.Statistical analysis were performed by using SPSS18.0 software was used for statistical analysis of the data,and the chi-square test of the success and failure cases of NOSE was used to analyze the data.The size of specimens was examined by t-test.P<0.05 was statistically significant. Results 7 cases of conversions to open abdominal incision occurred during operation.51(73.9%)patients,including 48(94.1%)cases of anal approach and 3(5.9%)cases of vagina approach,received successful NOSE after LCRs,while 18(26.1%)cases failed A lower success rate of NOSE occurred mainly in male patients with severe colon lesions and large tumor size.The mean size of removed specimens was(3.6±3.2)and(5.6±1.5)cm by using anal approach and vaginal approach respectively,and the mean tumor size of the failed cases was(6.6±4.4)cm(P<0.05). Conclusion Better prognosis could be achieved in patients with rectal cancer underwent laparoscopic resection+NOSE,while higher success rate could be achieved when milder lesions or in female patients.