NOSESⅡ式与常规腹腔镜中位直肠癌根治术疗效对比

Efficacy comparison of laparoscopic natural orifice specimen extraction surgery(NOSESⅡ)versus conventional laparoscopy for median rectal cancer

目的通过与常规腹腔镜手术临床疗效对比探究NOSESⅡ式在中位直肠癌根治术中的应用价值,探讨NOSESⅡ式在腹腔镜中位直肠癌根治术中安全性及有效性。方法回顾性分析2013年8月至2018年11月于哈尔滨医科大学附属第二医院结直肠肿瘤外科就诊的直肠癌患者141例,其中腹部无辅助切口手术患者55例,腹腔镜手术患者86例。比较两组的手术时间、术中出血量、术后排气时间、进食时间、住院时长、并发症、预后等差异。结果共有NOSESⅡ式组47例、常规腹腔镜组47例成功配对,两组手术时长、术中出血量、淋巴结清扫、及术后肛门功能评价差异无统计学意义(P>0.05)。与常规腹腔镜组相比,NOSESⅡ式组术后总并发症发生率较低(6.4%vs.21.3%,χ^(2)=6.085,P=0.036);术后排气时间明显短于常规腹腔镜组(38 h vs.48 h,t=-2.639,P=0.008);术后进食时间也明显短于常规腹腔镜组(59 h vs.84 h,t=-3.330,P=0.001);在术后总住院时长上也较腹腔镜组明显缩短[12(6~18)vs.12(9~30),t=-1.460,P=0.004];术后患者疼痛评分第一日(t=-4.463,P<0.001)、第三日(t=-4.975,P<0.001)、第五日(t=-5.706,P<0.001)镇痛药物的使用明显低于腹腔镜组(t=-4.325,P<0.001);此外,在生存分析方面,两组患者术后无疾病生存时间(DFS)和总生存时间差异均无统计学意义(P>0.05)。结论NOSESⅡ式作为一种安全有效的直肠癌根治手术方式,在确保完成手术根治直肠癌的治疗效果前提下,并不增加手术风险,并且在降低手术后总并发症、缩短术后排气时间、进食时间、术后住院时长,术后减痛等方面较常规腹腔镜手术具有明显优势。

Objective To assess the comparative efficacy of laparoscopic natural orifice specimen extraction surgery(NOSESⅡ)and laparoscopic radical resection(LAP)for middle rectal cancer.Methods In this retrospective analysis conducted from August 2013 to November 2018 at the Department of Colorectal Cancer Surgery,the Second Affiliated Hospital of Harbin Medical University,141 patients with rectal cancer were enrolled and divided into 2 groups by treated with NOSES or conventional LAP.The NOSESⅡgroup included 55 cases and the LAP group included 86 cases.The operative time,intraoperative blood loss,postoperative exhaust time,feeding time,length of hospital stay,complications,prognosis and other differences between the two groups were compared.Results Forty-seven pairs of cases were successfully matched and evaluated.The operative and postoperative information of the two groups was analyzed and compared,among which,there were no statistically significant differences in the operativeduration intraoperative blood loss,lymph node dissection,postoperative follow-up and postoperative anal function evaluation(P>0.05).The NOSESⅡgroup had lower incidences of total postoperative complications(6.4%vs.21.3%,χ^(2)=6.085,P=0.036),shorter postoperative exhaust time(38 h vs.48 h,t=-2.639,P=0.008),shorter postoperative feeding time(59 h vs.84 h,t=-3.330,P=0.001)and shorter total length of postoperative hospital stay[12(6~18)vs.12(9~30),t=-1.460,P=0.004]than the LAP group.Lower pain scores and the use of analgesics in the first,third and fifth postoperative days were recorded in the NOSESⅡgroup as compared to the LAP group(t=-4.463,P<0.001),(t=-4.975,P<0.001),(t=-5.706,P<0.001).In addition,in terms of survival analysis,two groups of patients with postoperative DFS and OS were not statistically difference(P>0.05).Conclusion The results indicate that NOSESⅡis a relatively safe and effective way for middle rectal cancer radical resection,with ensured efficacy of the operation not increasing risk of surgery,potential to reduce the total complications after surgery,shortened postoperative hospitalization duration,shortened postoperative exhaust time,shortened eating time,shortened postoperative time,improved pain relief.This article should ensure that NOSES has obvious advantages over the conventional laparoscopic surgery.