较大直肠癌NOSES与传统腹腔镜手术的临床资料比较

Comparison between natural orifice specimen extraction surgery and traditional laparoscopic resection for large rectal cancer

目的探讨较大直肠癌经自然腔道取标本手术(natural orifice specimen extraction surgery, NOSES)成功患者的临床特征。方法回顾性地将11例较大直肠癌NOSES病例及64例较大直肠癌传统腹腔镜手术病例纳入研究。收集患者临床资料,包括年龄、性别、体质量指数(body mass index, BMI)、肿瘤梗阻、肿瘤距肛缘距离、腹部手术史、手术方式、肿瘤病理结果、盆腔MRI测量的最大肿瘤直径和直肠系膜厚度。2组患者临床因素的差异使用卡方检验进行分析。结果较大直肠癌NOSES病例中,6例进行了双吻合器拖出式经直肠取标本手术(transrectal extraction of specimen-double stapling anastomosis, TRES-DSA),4例进行了单吻合器拖出式经直肠取标本手术(transrectal extraction of specimen-single stapling anastomosis, TRES-SSA),1例进行了翻出式经直肠取标本手术(transanal endorectal eversion and transection, TEET)。NOSES组与传统腹腔镜手术组的性别(P=0.657),年龄(P=0.416),腹部手术史(P=0.936),肿瘤梗阻(P=0.136),病理分期(P=0.138)和直肠系膜厚度(前后径:P=0.603;左右径P=0.352)差异无统计学意义。相对于传统腹腔镜手术组,NOSES组的BMI更低(P=0.007),肿瘤位置更低(P=0.002)。2组患者的生存(P=0.727)和复发(P=0.855)情况差异无统计学意义。结论相对于传统腹腔镜手术患者,较大直肠癌NOSES成功患者有更低的BMI和更低的肿瘤位置。术前综合评估BMI和肿瘤位置有助于选择合适的较大直肠癌病例进行NOSES。

Objective To assess the characteristics of patients for natural orifice specimen extraction surgery(NOSES) for large rectal cancer. Methods Clinical data of 11 patients with rectal cancer who underwent NOSES for laparoscopic rectal resection and 64 patients who received traditional laparoscopic rectal resection were retrospectively analyzed. The age, sex, body mass index(BMI), tumor obstruction, distance from the anal verge, history of abdominal surgery, type of surgery, pathological stages, maximum tumor diameter and width of mesorectum measured by pelvic MRI were compared between two groups. Results Among 11 patients who completed NOSES, 6 patients were treated with transrectal extraction of specimen-double stapling anastomosis(TRES-DSA), 4 patients were treated with transrectal extraction of specimen-single stapling anastomosis(TRES-SSA) and 1 patient was treated with transanal endorectal eversion and transection(TEET). There were no significant differences in sex(P=0.657), age(P=0.416), abdominal surgery history(P=0.936), tumor obstruction(P=0.136), pathological grading(P=0.138) and width of mesorectum(AP: P=0.603;LR: P=0.352) between two groups. Patients who completed NOSES were more likely to have a lower BMI(P=0.007) and a shorter distance of tumor from the anal verge(P=0.002) than patients who performed traditional laparoscopic rectal resection. Conclusion Rectal cancer patients with lower BMI and shorter distance from the anal verge would be more suitable for NOSES, preoperative assessment will facilitate the selection of patients for NOSES.