经自然腔道取标本手术在中低位直肠癌患者中的应用效果及安全性观察

Observation on the Application Effect and Safety of Natural Orifice Specimen Extraction Surgery in Patients with Middle and Low Rectal Cancer

目的:探究及观察经自然腔道取标本手术(NOSESⅠ式)在中低位直肠癌患者中的应用效果及安全性。方法:选取2020年1月-2021年8月武威肿瘤医院的100例中低位直肠癌患者为研究对象,将其随机分为对照组和观察组,每组50例。对照组进行常规腹腔镜手术治疗,观察组则进行NOSESⅠ式治疗。比较两组的并发症发生率、术后不同时间的疼痛程度(VAS评分)、镇痛药物应用率、首次排气时间、离床活动时间、进食时间、排便时间、二次手术率、排便功能评价(Wexner量表、LARS量表)及生存质量(EORTC QLQ-CR38量表)。结果:两组的并发症发生率及二次手术率比较,差异均无统计学意义(P>0.05);观察组的镇痛药物应用率显著低于对照组,差异有统计学意义(P<0.05)。术后1、3、7 d,观察组的VAS评分情况均显著优于对照组,差异均有统计学意义(P<0.05)。观察组首次排气时间、离床活动时间、进食时间及排便时间均显著短于对照组,差异均有统计学意义(P<0.05)。术后1个月,观察组的Wexner量表评分、LARS量表评分及EORTC QLQ-CR38量表评分均显著优于对照组,差异均有统计学意义(P<0.05)。结论:NOSESⅠ式在中低位直肠癌患者中的应用效果较好,安全性较高,在本类患者中的应用价值较高。

Objective:To investigate and observe the application effect and safety of natural orifice specimen extraction surgery (NOSES Ⅰ type) in patients with middle and low rectal cancer.Method:A total of 100 patients with middle and low rectal cancer from January 2020 to August 2021 in Wuwei Tumour Hospital were selected as the study objects,they were randomly divided into control group and observation group,with 50 cases in each group.The control group was treated with routine laparoscopic surgery,the observation group was treated with NOSES Ⅰ surgery.Then the complication rates,pain degree (VAS score) at different time after the operation,application rates of analgesic drugs,first exhaust time,out of bed activity time,eating time,defecation time,secondary operation rates,defecation function evaluation (Wexner scale and LARS scale) and quality of life (EORTC QLQ-CR38 scale) of two groups were compared.Result:There were no significant differences in complication rate and second operation rate between the two groups (P>0.05);the application rate of analgesics in the observation group was significantly lower than that in the control group,the difference was statistically significant (P<0.05).On postoperative day 1,3 and 7,the VAS scores of the observation group were significantly better than those of the control group,the differences were statistically significant (P<0.05).The first exhaust time,out-of-bed activity time,eating time and defecation time in the observation group were significantly shorter than those in the control group,the differences were statistically significant (P<0.05).At 1 month after operation,the scores of Wexner scale,LARS scale and EORTC QLQ-CR38 scale in the observation group were significantly better than those in the control group,the differences were statistically significant (P<0.05).Conclusion:NOSES Ⅰ type has a good effect and high safety in patients with middle and low rectal cancer,and its application value is higher in this type of patients.