经肛门与经腹壁取标本机器人辅助下直肠前切除术的近期疗效对比

Short-term outcomes of robot-assisted anterior resection with transanal and transabdominal retrieval of the specimen for rectal cancer:a comparative study

目的:比较经肛门与经腹壁取标本机器人下直肠前切除术的近期临床疗效。方法:回顾性分析2018年1月—2021年1月在甘肃省人民医院肛肠科135例行机器人直肠癌前切除术患者的临床资料。按手术入路不同将纳入的患者分为对照组和经自然腔道标本取出手术(Natural Orifice Specimen Extraction Surgery,NOSES)组,其中对照组经腹壁取出标本(72例),NOSES组经肛门取出标本(63例),比较两组患者基本资料、术中和术后相关指标、并发症发生率和随访情况。结果:与对照组相比,NOSES组术后排气时间、流质饮食时间、下床活动时间和术后住院时间均明显缩短(P<0.05),并且术后第1d疼痛评分较低(P<0.05)。两组手术时间、术中失血量、术后3个月肛门功能评分、淋巴结清扫数、病理学分型、分级和AJCC分期相比,差异无统计学意义(P>0.05);两组术后并发症发生率分别为6.3%(4/63)和8.3%(6/72),差异无统计学意义(P>0.05)。NOSES组平均随访10.3月,对照组平均随访11.5月,两组患者随访过程中均无肿瘤复发,无腹壁切口疝、造口旁疝、造口坏死等严重并发症。结论:经肛门取出标本机器人辅助下直肠癌前切除术术后疼痛感显著减轻,术后下床活动时间明显缩短,更有利于胃肠道功能的快速恢复,且具有更好的腹部术后美容效果。

Objective:To compare short-term outcomes of robot-assisted anterior resection with transanal and transabdominal retrieval of the specimen for rectal cancer.Methods:135 patients underwent robot-assisted anterior resection for rectal cancer with transabdominal and transanal retrieval of the specimen from January 2018 to January 2021 were included in this study.The selected patients were divided into the control group(n=72)and the Natural orifice specimen extraction surgery(NOSES)group(n=63)based on different surgical approaches.Patients’perioperative data,postoperative complications,and follow-up results were compared between the two groups.Results:Compared to the control group,the NOSES group had shorter time to first flatus and liquid diet,earlier onset time of postoperative off-bed activities,less length of hospital stay,and less pain score one day after surgery,the differences were statistically significant(P<0.05).There were no significant differences between the two groups on the operative time,volume of blood loss,Wexner score 3-month after surgery,the pathological type,pathological grading,and AJCC stage(P>0.05).The incidence of postoperative complications in the two groups was 6.3%(4/63)and 8.3%(6/72)respectively,and the difference was not statistically significant(P>0.05).Patients in the NOSES group were followed up with an average time of 10.3 months,and patients in the control group were 11.5 months.No serious complications were found during the follow-up in the two groups.Conclusion:Robot-assisted anterior resection with transanal retrieval of the specimen for rectal cancer has less pain after surgery,earlier onset time of postoperative off-bed activities,quicker recovery of gastrointestinal function,and better abdominal cosmetic effect.