NOSES在低位直肠癌保肛手术中的临床观察

Clinical effects of NOSES in anus reserved for low rectal cancer

目的研究经自然腔道取标本手术(NOSES)在低位直肠癌根治中的近中期临床疗效。方法回顾性分析2017年1月至2019年4月收治的低位直肠癌(Tis-T3,N0,M0)未行预防性造瘘手术的患者的临床资料共109例;按术式分组,A组57例行腹腔镜下腹部辅助切口移除标本手术(Dixon);B组25例行经自然腔道取标本手术(NOSES-Ⅰ式A法),C组27例行经自然腔道取本手术(NOSESⅠ式E法,改良Bacon)。比较三组一般资料、围手术期指标、术后回访评估肛门功能、并发症情况及无病生存期等数据。结果BMI在B组最小(F=9.62,P<0.05),其余两组差异无统计学意义;肿瘤位置C组最低(F=18.77,P<0.05),A组与B组比较差异无统计学意义。B组与C组在开始进食时间方面与A组差异无统计学意义(F=8.07,χ^(2)=5.34;P>0.05),但C组优于B组;导尿时间与拔除引流管时间C组明显优于其他两组(χ^(2)=7.59,F=7.48;P<0.05),A组与B组差异无统计学意义(P>0.05)。住院费用方面C组为3组中最少(F=9.51,P<0.05),余围手术期指标3组间差异均无统计学意义(P>0.05)。12个月Vaizey量表评分A组及B组优于C组(χ^(2)=12.04,P<0.05);24个月Vaizey量表评分组间差异无统计学意义(χ^(2)=5.04,P>0.05)。全部患者并发症率为26.6%,B组为29.65%,高于A组(26.33%)和C组(20.21%),但3组间差异无统计学意义(χ^(2)=0.48,P>0.05)。2年0例患者局部复发;2年无病生存期分别为94.7%,96.0%和88.9%(χ^(2)=1.36,P>0.05);3组患者远处转移率为4.6%,4.0%和11.1%,差异无统计学意义(χ^(2)=2.19,P>0.05)。结论NOSES在低位直肠癌根治中是安全可靠的,同时具有良好的肿瘤学预后以及较好地保留了肛门功能。

Objective To observe the short mid-term clinical effects of natural orifice specimen extraction surgery(NOSES)in the radical treatment of low rectal cancer.Methods A retrospective analysis of the clinical datum of 109 patients with low rectal cancer(Tis-T3,N0,M0)who had not undergone preventive sotma from January 2017 to April 2019 was grouped by different surgical procedure.Group A including 57 cases underwent laparoscopic with abdominal incision surgery(Dixon),25 patients in group B underwent natural orifice specimen extraction surgery(NOSESⅠ-A type),and 27 patients in group C underwent natural orifice specimen extraction surgery(NOSESⅠ-E type,modified Bacon).The general datum,perioperative indexes,postoperative follow-up assessment of anal function,compications and disease-free survival were compared between the three groups.Results BMI was minimal in group B(F=9.62,P<0.05),and there was no statistical difference in the remaining groups;the tumor position in group C was the lowest(F=18.77,P<0.05),and there was no statistical difference between the group A and the group B.The groups B and C in hospitalization expenses and the postoperative feed time were no statistical difference with group A(F=8.07,χ^(2)=5.34;P>0.05),but the group Cwas better than the group B.The group C was significantly better than other two groups in the time of indwelling catheter and extracted drainage tube(χ^(2)=7.59,F=7.48;P<0.05),and there was no statistical difference between the group A and the group B.Remainal indicators of perioperative period were no significant difference.The Vaizey scale scores of group A and group B were better than group C at 12 months after surgery(χ^(2)=12.04,P<0.05),but the scores were not statistically significant at 24 months after surgery(χ^(2)=5.04,P>0.05).All patients had a complication rate of 26.6%.The group B was 29.65%,which was higher than the group A(26.33%)and group C(20.21%),but there was no statistical difference(χ^(2)=0.48,P>0.05).There was no patient occurred by local recurrence after 2 years surgery.2-year disease-free survivals were 94.7%,96.0%and 88.9%(χ^(2)=1.36,P>0.05).There was no statistical difference in distant metastasis rate among the three groups(χ^(2)=2.19,P>0.05).Conclusion NOSES is safe and reliable in the radical treatment of low rectal cancer and have a good oncologic prognosis and good preservation of anal function.