三孔NOSES与传统腹腔镜直肠癌根治术治疗直肠癌临床疗效比较

Comparison of clinical efficacy between three-port NOSES and traditional laparoscopic radical rectal resection for rectal cancer

目的比较三孔腹腔镜下经自然腔道取标本术(NOSES)直肠癌根治术(Dixon)与传统腹腔镜直肠癌根治术的临床疗效及安全性。方法回顾性分析2019年1月—2021年2月重庆大学附属肿瘤医院胃肠外科手术治疗直肠癌患者84例的临床资料,其中传统腹腔镜直肠癌根治术治疗42例(腹腔镜组),NOSES治疗42例(NOSES组)。比较2组手术期指标(手术时间、术中出血量、淋巴结清扫数目)、术后康复指标(首次排气时间、首次下床时间、止痛药使用次数、术后住院时间)、并发症发生情况等。结果NOSES组手术时间长于腹腔镜组(t/P=6.152/<0.001),术中出血量、淋巴结清扫数目比较差异无统计学意义(P>0.05);NOSES组术后首次排气时间、首次下床时间、止痛药使用次数及住院天数少于腹腔镜组(t/P=8.225/<0.001,2.986/0.004,4.774/<0.001,3.754/<0.001)。2组术后并发症总发生率比较差异无统计学意义(P>0.05)。结论三孔NOSES手术应用于直肠癌根治性切除术安全、可行、有效,恢复快、更微创,值得在临床推广应用。

Objective To compare the clinical efficacy and safety of three-port laparoscopic natural orifice specimen collection(NOSES)radical rectal cancer surgery(Dixon)and traditional laparoscopic radical rectal cancer surgery.Methods The clinical data of 84 patients with rectal cancer treated by Gastrointestinal Surgery in Chongqing University Affiliated Cancer Hospital from January 2019 to February 2021 were retrospectively analyzed.Among them,42 patients were treated with traditional laparoscopic radical rectal resection(laparoscopic group),and 42 patients were treated with NOSES.42 cases(NOSES group).The operative indicators(operation time,intraoperative blood loss,number of lymph node dissections),postoperative rehabilitation indicators(the first exhaust time,the first time to get out of bed,the number of analgesics uses,the postoperative hospital stay),and the incidence of complications were compared between the two groups.situation etc.Results The operation time in the NOSES group was longer than that in the laparoscopy group(t/P=6.152/<0.001),and there was no significant difference in the amount of intraoperative blood loss and the number of lymph node dissections(P>0.05).The time in bed,the number of analgesic use and the length of hospital stay were less than those in the laparoscopy group(t/P=8.225/<0.001,2.986/0.004,4.774/<0.001,3.754/<0.001).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).Conclusion Three-port NOSES operation is safe,feasible and effective in radical resection of rectal cancer,with faster recovery and less invasiveness.It is worthy of clinical application.