NOSES-I式B法与腹腔镜经括约肌间切除术在低位直肠癌中的对比研究

NOSES- I B method versus laparoscopic intersphincter resection in low rectal cancer

目的对比研究经自然腔道取标本手术(NOSES)I式B法与腹腔镜经括约肌间切除术(ISR)在低位直肠癌中的临床效果。方法前瞻性选取2017年6月至2021年6月确诊为低位直肠癌的患者100例,随机数字表法将其分为两组,每组各50例,NOSES组行NOSES-I式B法,ISR组行ISR。比较两组患者围手术期指标、术后并发症及肛门直肠功能。采用统计学软件SPSS20.0完成数据分析,术后并发症、Kirwan分级等计数资料组间比较行x?检验;围手术期指标、Wexner评分等计量资料用(x士s)表示,组间比较行t检验。P<0.05为差异有统计学意义。结果NOSES组手术时间、首次排气时间、术后住院时间等指标均短于ISR组(P<0.05);两组术后并发症总发生率比较,差异无统计学意义(P>0.05);NOSES组患者术后6月、12月Wexner评分显著低于ISR组(P=0.000);NOSES组Kirwan分级情况优于ISR组(P=0.029)。结论低位直肠癌患者行NOSES-I式B法治疗相比ISR术,手术时间短,术中出血少,可有效保护患者直肠肛门功能,更利于其术后恢复。

Objective This study is a comparison of the clinical effect of the B-i method of natural NOSES versus laparoscopic intersphincter resection(ISR)in low rectal cancer.MethodsA total of 100 patients diagnosed with low rectal cancer between June 2017 and June 2021 were prospectously assigned to two groups with 50 patients in each group using a random number table method.The NOSES group receives the Tnoses I B method and the ISR group receives the ISR.Perioperative indexes,postoperative complications and anorectal function were compared between the two groups.Statistical software SPSS 20.O was used to complete the data analysis,and the statistical data such as postoperative complications and Kirwan grading were compared between groups by x^(2) test.Measurement data such as perioperative indicators and Wexner score were represented by(x±s).Comparison between groups was performed by t test.P<0.05 was considered statistically significant.ResultsNOSES group has shorter operating time,first exhaust time,and postoperative hospital stay than ISR group(P<0.05);There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).The Wexner score of the NOSES group was significantly lower than that of the ISR group 6 months and 12 months after surgery(P=0.00);NOSES group Kirwan grading is superior to ISR group(P=0.029).ConclusionThis NOSES I type B therapy in patients with low rectal cancer has shorter operation time and less intraoperative bleeding than ISR,which effectively protects patients'rectal and anal function and is more beneficial to postoperative recovery.