系膜优先,外拉内推外翻法在直肠癌NOSES手术中的应用

Application of mesentery prior,pulling and pushing method for NOSES in rectal cancer

目的探讨对于肥胖和系膜肥厚的低位直肠癌患者,在行NOSESⅠ式手术时采用系膜优先,外拉内推法的应用效果。方法回顾性分析2017年1月至2020年12月在中国医学科学院肿瘤医院结直肠外科行NOSESⅠA/ⅠB法的55例患者的临床资料,分析患者的手术时间、出血量、获取淋巴结活检个数、肿瘤最大径、下切缘距离、切除肠管长度、围术期恢复情况等手术相关指标,探讨该方法的安全性和有效性。结果55例患者均采用系膜优先,外拉内推法完成NOSESⅠ式手术,无中转开腹病例。BMI在24~28 kg/m2的患者41例,在28~33 kg/m2的患者14例。中位手术时间180 min(84 min,339 min),中位出血量30 mL(10 mL,200 mL),中位获取淋巴结活检个数18个(9个,45个),中位肿瘤最大径3 cm(1 cm,7 cm),中位下切缘距离2 cm(1 cm,3 cm),中位切除肠管长度11 cm(7.5 cm,29 cm)。中位排气时间2天(1天,5天),中位术后住院时间7天(4天,22天)。围术期并发症发生率5.5%(3/55)。结论对于肥胖和系膜肥厚的低位直肠癌患者,NOSESⅠ式中采用“系膜优先,外拉内推外翻”的方法安全可行。

Objective To explore the effect of mesentery prior,pulling and pushing method for NOSESⅠin lower rectal cancer patients with obesity or fat mesentery.Methods This is a retrospective analysis of 55 patients with rectal cancer admitted to Department of Colorectal Surgery,Cancer Hospital,Chinese Academy of Medical Sciences,between January 2017 and December 2020.All patients received NOSESⅠ.The following were recorded:duration of surgery,intraoperative blood loss,the number of lymph nodes harvested,the maximum diameter of the tumor,the distance of the inferior resection margin,the length of the excised bowel,duration of hospitalization and complication.And the safety and effectiveness of the operation was explored.Results Surgery was successfully finished in all 55 patients with mesentery prior,pulling and pushing method.There are 41 patients with BMI between 24 and 28 kg/m2,and 14 patients with BMI between 28 and 33 kg/m2.The median duration of surgery was 180 min(84 min,339 min),the median intraoperative blood loss was 30 mL(10 mL,200 mL),the median number of lymph nodes harvested was 18(9,45),the median maximum diameter of the tumor was 3 cm(1 cm,7 cm),the median distance of the inferior resection margin was 2 cm(1 cm,3 cm),the median length of the excised bowel was 11 cm(7.5 cm,29 cm),the median exhaust time was 2 d(1 d,5 d),the median duration of hospitalization was 7 d(4 d,22 d)and complication rate was 5.5%(3/55).Conclusion Mesentery prior,pulling and pushing method for NOSES in rectal cancer patients with obesity or fat mesentery was safe and effective.