NOSES用于直肠癌根治术的临床疗效及对患者生活质量的影响研究

Clinical efficacy and quality of life with natural orifice specimen extraction (NOSES) surgery for rectal cancer

目的研究NOSES用于直肠癌根治术中的临床疗效及对患者生活质量的影响。方法选取本院2018年1月至2019年1月期间收治的84例直肠癌患者为研究对象,以随机数字表法分为观察组与对照组,每组各42例。对照组行常规腹腔镜直肠癌根治术治疗,观察组行腹腔镜NOSES直肠癌根治术。观察记录两组手术时间、术中出血量、术后下床时间、术后排气时间、淋巴结清扫数量、住院时间,两组治疗前后生活质量评分及术后并发症发生情况。结果观察组手术时间长于对照组,差异有统计学意义(P <0.05);观察组术中出血量少于对照组,术后下床时间、术后排气时间、住院时间短于对照组,差异均有统计学意义(均P <0.05)。观察组治疗后功能、症状、整体生活质量、单项测量项目评分高于治疗前及对照组治疗后,差异均有统计学意义(均P <0.05)。观察组术后并发症总发生率为11.90%,与对照组(14.29%)对比差异无统计学意义(P> 0.05)。结论 NOSES用于直肠癌根治术中治疗直肠癌可减少术中出血量,缩短术后下床时间及术后排气时间,促进康复,提高患者生活质量。

Objectives To investigate the clinical efficacy and quality of life with natural orifice specimen extraction(NOSES in patients undergoing rectal cancer surgery. Methods Eighty-four patients with rectal cancer treated in our hospital between January 2018 and January 2019 were randomly divided into treatment group(n = 42) and control group(n = 42) by using random number table. Patients in the control group received conventional laparoscopic resection of rectal cancer. Patients in the treatment group received laparoscopic rectal cancer resection with NOSES. The followings were recorded and compared between the two groups: duration of surgery, amount of intraoperative blood loss, postoperative time of out of bed, time to first bowel movement, lymph node yield, duration of hospitalization, quality of life before and after surgery, and postoperative complications.Results The duration of operation was significantly longer and the intraoperative blood loss was significantly less in the treatment group than in the control group(P < 0.05). The postoperative time out of bed after surgery, the time to first bowel movement and the duration of hospitalization were significantly shorter in the treatment group(P < 0.05). Functional scales, symptom scales, global health status, each symptom scale after surgery were significantly higher than those before surgery in the treatment group, they were also significantly higher than those after surgery in the control group(P < 0.05). Postoperative complications were comparable between the treatment group and the control group(11.90% vs. 14.29%, P > 0.05). Conclusion NOSES could reduce intraoperative blood loss, shorten postoperative time out of bed and time to first bowel movement, promote recovery and improve patients’ quality of life in laparoscopic resection of rectal cancer.