经自然腔道取标本的腹腔镜下右半结肠癌根治术安全性研究

Study on the safety of laparoscopic radical resection of right colonic cancer

目的探讨经自然腔道取标本(NOSES)的腹腔镜下右半结肠癌根治术临床应用的安全性。方法回顾性分析2017年9月至2019年12月行腹腔镜下右半结肠癌根治术治疗的90例患者资料,根据手术方式不同将其分为两组,其中42例行NOSES的腹腔镜下右半结肠癌根治术(NOSES组),48例采用传统腹腔镜下右半结肠癌切除术(TLC组)。选用SPSS 22.00统计软件进行分析。围术期指标等计量资料用(x±s)表示,采用独立t检验;腹腔冲洗液肿瘤细胞学检测结果、术后并发症发生率等计数资料采用χ^2检验;病理分期、组织学分级等级资料采用秩和检验;总生存率和无病生存率采用Kaplan-Meier生存分析;P<0.05差异有统计学意义。结果两组腹腔冲洗液肿瘤细胞阳性率为0%,NOSES组细菌培养阳性率为30.9%(13/42)小于TLC组31.2%(15/48),差异无统计学意义(P=0.976);相比于TLC组,NOSES组手术时间较长,肛门排气时间、术后住院时间较短,术中出血量更少(P<0.05);NOSES组3年总生存率为90.5%、无病生存率为88.1%,TLC组3年总生存率为93.8%、无病生存率为87.5%,差异均无统计学意义(P>0.05);两组手术前后盆底功能差异无统计学意义(P>0.05)。结论经自然腔道取标本的腹腔镜下右半结肠癌根治术具有良好的近期疗效且不影响患者盆底功能,临床上安全可行。

Objective To evaluate the safety of the clinical application of laparoscopic radical resection of right colonic carcinoma taken from natural cavity.Methods Retrospectively analyzed the data of 90 patients with right colon cancer who underwent laparoscopic radical resection in our hospital and The First Affiliated Hospital of Chongqing Medical University from September 2017 to December 2019,and divided them into NOSES group and TLC group according to different surgical methods,of which 42 Routine laparoscopic radical resection of right colonic cancer(NOSES group)was performed through the natural cavity,and 48 patients underwent traditional laparoscopic colorectal cancer resection(TLC group).SPSS 22.00 statistical software was used for data analysis.Measurement data such as perioperative indicators were represented by (x±s) and independent t-test was used;Tumor cytology test results and postoperative complication rate were measured byχ^2 test.Rank sum test was used for the data of pathological stage and histological grade.Overall and disease-free survival rates were analyzed by Kaplan-Meier survival analysis.P<0.05 was statistically significant.Results The positive rate of tumor cells in the peritoneal lavage fluid of the two groups was 0%,and the positive rate of bacterial culture in the NOSES group was 30.9%(13/42)than that in the TLC group was 31.2%(15/48),the difference was not statistically significant(P=0.976);phase Compared with the TLC group,the NOSES group had a longer operation time,shorter anal exhaust time,postoperative hospital stay,and less intraoperative blood loss.The difference was statistically significant(P<0.05);The 3-year survival rate is 90.5%,and the disease-free survival rate is 88.1%in the NOSES group,In TLC group,the 3-year overall survival rate was 93.8%and the disease-free survival rate was 87.5%.The differences were not statistically significant(P>0.05).there was no statistical difference in pelvic floor function between the two groups before and after surgery(P>0.05).Conclusion Laparoscopic radical resection of the right colonic carcinoma taken through the natural cavity has good short-term curative effect and does not affect the patient’s pelvic floor function.It is clinically safe and feasible.