末端回肠悬吊联合经自然腔道取标本在低位直肠癌保肛术中的应用研究

Application of terminal ileum suspension combined with natural orifice specimen extraction in anus-preserving surgery for low rectal cancer

目的探讨末端回肠悬吊术联合经自然腔道取出标本(NOSES)手术在低位直肠癌保肛术中的应用。方法选取2017年5月至2018年11月期间,无锡市第三人民医院收治的60例低位直肠癌患者,随机分为:常规腹腔镜手术组、末端回肠造口+NOSES组和末端回肠悬吊+NOSES组。比较3组患者手术时间、术中出血量、术后恢复情况、术后并发症及术后疼痛评分。结果所有患者均顺利完成手术,3组患者术中出血量及术后吻合口漏发生率比较,差异无统计学意义(均P> 0.05);行NOSES手术时间略长于常规腹腔镜组[(189.3±15.9)min、(183.5±19.7)min vs.(169.8±18.3)min],差异有统计学意义(P <0.05)。末端回肠悬吊+NOSES组首次排气时间长于其他两组,术后平均住院时间(9.9±3.5)d短于其他两组,差异有统计学意义(均P <0.05)。3组患者切口感染、泌尿系并发症的发生率差异有统计学意义(P <0.05),行NOSES手术的两组,切口感染、泌尿系并发症发生率低于常规腹腔镜手术组患者,差异均有统计学意义(P <0.05);术后疼痛方面,末端回肠造口+NOSES组优于常规腹腔镜组,末端回肠悬吊+NOSES优于末端回肠造口+NOSES组,差异均具有统计学意义(P <0.05)。结论末端回肠悬吊术联合NOSES手术应用于低位直肠癌保肛术,更有利于患者术后康复。

Objective To study the value of terminal ileum suspension combined with natural orifice specimen extraction surgery(NOSES)in laparoscopic radical resection for low-rectal cancer. Methods 60 patients with low rectal cancer in Third People′s Hospital of Wuxi from May 2017 to November 2018 were enrolled and randomly divided into 3 groups:Group of terminal ileostomy combined with laparoscopic surgery(conventional laparoscopic surgery group,n=20),Group of the terminal ileostomy combined with NOSES(n=20)and Group of the terminal ileum suspension combined with NOSES group(n=20). Patients’ perioperative and postoperative outcomes,visual analog scale scores were compared. Results There was no significant difference between the three groups in terms of intraoperative blood loss and the rate of anastomotic leak(P > 0.05). Patients with NOSES have a slightly longer time than that of the conventional laparoscopic group in operation time(189.3 ± 15.9 min,183.5 ±19.7 min vs 169.8 ± 18.3 min,P < 0.05). Group of terminal ileal suspension combined with NOSES had longer time at the first exhaust,but shorter time at the average postoperative hospital stay(9.9 ± 3.5)days compared with the other two groups. Patients with NOSES have a low incidence of wound infection and urinary complication. The pain scores of the postoperative first,second,and third days were significantly lower in the Group of the terminal ileum suspension combined with NOSES. Conclusion Terminal ileum suspension combined with NOSES provids more benefits for postoperative recovery in laparoscopic radical resection for low-rectal cancer.