NOSES在ERAS理念下对左半结肠癌患者术后应激与康复的影响

Effect of NOSES on Postoperative Stress and Recovery in Left Colon Cancer Patients with the Concept of ERAS.

目的探讨在加速康复外科(enhanced recovery after surgery concept,ERAS)理念下经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)对左半结肠癌患者术后应激指标及恢复的影响。方法选取2019年10月~2020年8月大连大学附属中山医院收治的60例左半结肠癌患者,采用随机数字表法将其分为NOSES+ERAS组(n=31)和ERAS组(n=29)。NOSES+ERAS组患者采用在ERAS理念下的NOSES,ERAS组患者采用在ERAS理念下的腹腔镜结肠癌根治术。比较两组患者的术后临床恢复指标(术后首次排气时间、进流食时间、首次排便时间、术后住院时间),实验室检查指标[白细胞计数(white blood cell,WBC)、C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)、血清淀粉样蛋白A(serum amyloid A protein,SAA)],术后并发症的发生情况以及术后疼痛数字分级评分(numerical rating scale,NRS)。结果与ERAS组比较,NOSES+ERAS组患者的术后首次排气时间、进流食时间、首次排便时间及住院时间均缩短(P均<0.05);术后第3天的WBC降低(P<0.05),术后第1、3、5天的CRP、IL-6、SAA水平降低(P<0.05);术后并发症发生率降低(P<0.05);术后12、24、48h的疼痛NRS评分降低(P<0.05)。结论NOSES在ERAS理念下可以有效减少左半结肠癌患者术后疼痛、住院时间、首次排气时间、首次排便时间、进流食时间,降低机体炎症,减少瘢痕,促进患者恢复。

Objective To explore the effect of enhanced recovery after surgery(ERAS)concept combined with natural orifice specimen extraction surgery(NOSES)on perioperative stress indicators and postoperative recovery in patients with left colon cancer.Methods Sixty patients with the left colon cancer admitted to the Affiliated Zhongshan Hospital of Dalian University from October 2019 to August 2020 were selected and divided into the NOSES+ERAS group(n=31)and ERAS group(n=29)using random number table method.The patients in the NOSES+ERAS group underwent NOSES with the concept of ERAS,the patients in the ERAS group underwent laparoscopic radical resection of left colon cancer with the concept of ERAS.The postoperative clinical recovery indexes(postoperative first exhaust time,first defecation time,fluid feeding time,hospital stay time),laboratory examination indicators[white blood cell count(WBC),C-reactive protein(CRP),interleukin-6(IL-6)and serum amyloid A protein(SAA)],the occurrence of postoperative complications and numerical rating scale(NRS)of postoperative pain were compared.Results Compared with the ERAS group,postoperative first exhaust time,fluid feeding time,first defecation time and hospital stay time were shortened in the NOSES+ERAS group(P<0.05);WBC in the NOSES+ERAS group decreased at the 3rd day after operation(P<0.05),the levels of CRP,IL-6 and SAA at the 1,3 and 5days after operation were decreased(P<0.05);the incidence of complications was decreased(P<0.05);and the pain NRS scores at 12h,24h,48h after surgery were all decreased(P<0.05).Conclusion NOSES with the concept of ERAS can effectively reduces postoperative pain,length of hospital stay,first exhaust time,reduces inflammation,reduces scarring,and promotes recovery in patients with left colon cancer.