结直肠肿瘤经自然腔道取标本手术203例回顾性研究

Retrospective study of 203 cases of colorectal neoplasms treated by natural orifice specimen extraction surgery

目的通过对结直肠肿瘤经自然腔道取标本手术(NOSES)病例进行回顾性研究,探讨NOSES的可行性和安全性。方法纳入2013年5月至2017年5月行NOSES手术的结直肠肿瘤患者203例,收集资料包括患者术前一般资料、术后病理资料、手术资料及随访资料。结果患者平均年龄为(58.7±11.9)岁,平均BMI指数为(22.6±3.0)kg/m2,肿瘤位于直肠者占70.8%。术后病理资料显示,中分化腺癌者占69.4%,平均检出淋巴结(12.9±5.1)枚,平均肿瘤最大直径为(3.6±1.4)cm,TNM分期I～IV期患者分别占23.2%,41.4%,24.1%和3.4%。手术资料显示平均手术时间为(198.9±55.2)分钟,平均术中出血量为(73.7±54.2)mL;经直肠取标本者占87.2%,经阴道取标本者占12.8%;平均术后排气时间为(44.5±20.5)小时,平均进食时间为(63.8±15.5)小时。患者术后平均住院(12.3±4.1)天,11.9%的患者出现了术后并发症,住院期间二次手术者仅2例。随访资料显示术后肛门功能障碍者仅占2.2%,无阴道功能障碍者。结论 NOSES术具有良好的可行性、安全性及近期疗效,但仍需在临床实践中不断探索和发展。

Objective To study the feasibility and safety of natural orifice specimen extraction surgery(NOSES)in colorectal neoplasms by collecting the NOSES cases in colorectal surgery.Methods 203 patients with colorectal cancer who underwent NOSES from May 2013 to May 2017 were enrolled.Data were collected including preoperative general data,postoperative pathological data,operative data and follow-up data.Results The average age of patients was(58.7±11.9)years,the average BMI was(22.6±3.0)kg/m2,70.8%of neoplasms located in rectal.Pathological results showed that the proportion of middle differentiated adenocarcinoma was 69.4%,the average number of lymph node count was 12.9±5.1 and the average maximum diameter of tumor was(3.6±1.4)cm.The patients in stage I to IV were 23.2%,41.4%,24.1%and 3.4%respectively.87.2%of the patients were treated with rectal specimen extractions and 12.8%by vaginal extractions.The average operation time was(198.9±55.2)minutes and the average blood loss was(73.7±54.2)mL.The average postoperative exhaust time was(44.5±20.5)hours and the average postoperative feeding time was(63.8±15.5)hours.The average postoperative hospital stay was(12.3±4.1)days and the incidence of complications was 11.9%,only two cases received reoperation in the period of hospitalization.The follow-up data showed that postoperative anal dysfunction accounted for 2.2%of total cases and no vaginal dysfunction was detected.Conclusion NOSES in colorectal neoplasms seems to be safe and feasible and the short-term effect of NOSES is good.This technology still need to be explored in clinical practice in the future.