螺纹扩肛器应用于自然腔道取标本手术治疗超低位直肠癌的安全性及优势

The safety and advantages of using threaded anal reamer in natural cavity sampling operation for ultra-low rectal cancer

目的探讨螺纹扩肛器应用于自然腔道取标本手术(NOSES)治疗超低位直肠癌的安全性及优势。方法回顾性分析2017年5月至2019年8月70例超低位直肠癌手术患者的临床资料,根据术式不同将患者分为两组,Bacon组行改良Bacon术经自然腔道取标本,扩肛器组应用螺纹扩肛器完成经自然腔道取标本术,每组各35例。采用软件SPSS 23.0进行统计学分析。围手术期指标、肛门功能评分(Wexner.Vaizey评分)等计量资料以(x±s)表示,采用独立样本t检验;术后并发症等计数资料采用χ^(2)检验;P<0.05表示差异有统计学意义。结果Bacon组手术时间明显低于扩肛器组(P<0.05),而扩肛器组术中出血量、术后首次排气时间、住院时间均优于改良Bacon组(P<0.05);两组患者淋巴结清扫数目差异无统计学意义(P>0.05);术后6个月和12个月,两组患者Wexner评分、Vaizey评分均有所降低,肛门功能逐渐恢复,且扩肛器组评分均显著低于Bacon组(P<0.05);术后扩肛器组总并发症发生率明显低于改良Bacon组(5.7%vs.22.9%,P<0.05);截止2020年9月,所有患者平均随访时间(15.2±2.8)个月,两组患者均未发生肿瘤复发或转移。结论超低位直肠癌手术应用螺纹扩肛器于自然腔道取标本,可明显减少并发症的发生,降低术中出血量,对保留患者肛门括约肌,提升术后肛门功能有显著效果。

Objective To investigate the safety and advantages of screw-thread anal dilator in the treatment of ultra-low rectal cancer in natural orifice specimen extraction surgery(NOSES).Methods The clinical data of 70 patients undergoing surgery for ultra-low rectal cancer from May 2017 to August 2019 were retrospectively analyzed.The patients were divided into two groups according to different surgical methods:Bacon group underwent improved Bacon method of sampling through natural cavity,and the anal dilator group underwent threaded anal dilator to complete the natural cavity,with 35 cases in each group.SPSS23.0 was used for statistical analysis.Perioperative indexes,anal function score(Wexner,Vaizey score)and other measurement data were expressed as(x±s),and independent t test was used.Postoperative complications were analyzed by χ^(2) test.P<0.05 indicated statistically significant difference.Results The operation time of the Bacon group was significantly lower than that of the anal dilator group(P<0.05),while the intraoperative blood loss,first exhaust time and hospital stay of the anal dilator group were better than those of the improved Bacon group.(F<0.05).There was no significant difference in the number of lymph node dissection between the two groups(P>0.05).At 6and 12 months after surgery,Wexner score and Vaizey score were decreased,anal function gradually recovered,and the scores of the anal expander group were significantly lower than that of Bacon group(P<0.05).The incidence of postoperative complications in the anal reamer group was significantly lower than that in the modified Bacon group(5.7%vs.22.9%,P<0.05).By September 2020,all patients were followed up,with an average follow-up time of(15.2±2.8)months.No tumor recurrence or metastasis occurred in both groups.Conclusion The application of threaded anal reamer in the natural cavity for the operation of ultra-low rectal cancer can significantly reduce the occurrence of complications,reduce the amount of intraoperative blood loss,preserve the anal sphincter of patients and improve the postoperative anal function.