抵钉座体外置入法经肛门外翻切除标本腹部无辅助切口腹腔镜低位直肠癌根治术的近期疗效

Short-term efficacy of natural orifice specimen extraction surgery for low rectal cancer using a prolapsing technique

目的探讨抵钉座体外置入法在经肛门外翻切除标本的腹部无辅助切口腹腔镜低位直肠癌根治术中的近期疗效及应用价值。方法回顾性分析2015年6月至2018年6月在河南大学淮河医院肛肠外科接受腹腔镜低位直肠癌根治术的52例患者的临床资料,其中26例行抵钉座体外置入法经肛门外翻切除标本的腹部无辅助切口手术(NOSES组),26例行传统腹壁小切口取标本手术(LAP组)。并对其术中、术后资料进行分析。结果两组共52例患者手术均顺利完成,无中转开腹病例,两组患者手术时间、术中出血量、淋巴结清扫数目、术后并发症发生率、环周切缘情况、术后随访情况及术后肛门功能比较,差异均无统计学意义(均P>0.05)。与LAP组相比,NOSES组术后胃肠道功能恢复时间、术后住院时间均更短,术后疼痛评分、额外镇痛药物使用率更低,住院费用更少,患者对术后腹壁外观满意程度更高(均P<0.05)。结论抵钉座体外置入法经肛门外翻切除标本的腹部无辅助切口腹腔镜低位直肠癌根治术近期疗效满意,且在减轻术后疼痛、缩短术后住院时间、降低住院费用、腹壁外观更加美观等方面具有优势。

Objective To study the short-term outcomes and value of natural orifice specimen extraction surgery for low rectal cancer using a prolapsing technique. Methods From Jun 2015 to Jun 2018, 52 patients with low rectal cancer were divided into natural orifice specimen extraction surgery group (NOSES group, 26 cases) and laparoscopic low anterior resection group (LAP group, 26 cases). Results There were no significant differences on the operation time, intraoperative blood loss, lymph node dissection, postoperative complication rate, circumferential margin, postoperative follow-up and postoperative anal function between the two groups (all P >0.05). Compared with the LAP group, the patients in NOSES group had shorter gastrointestinal function recovery time and length of stay, lower postoperative pain score, lower analgesic drug use rate, lower hospitalization cost, and better cosmetic results(all P < 0.05). Conclusions The short-term efficacy of patients in NOSES group is satisfactory, which has the advantages of recovery enhancement and expenditure.