电子结肠镜辅助经结肠取标本手术在结肠肿瘤中的临床应用分析

Application of colonoscope assisted transcolonic specimen extraction surgery in colonic neoplasms

目的分析电子结肠镜辅助经结肠NOSES患者的临床资料,总结临床诊疗经验,探讨经电子结肠镜取标本的临床可行性。方法回顾性分析郑州大学第一附属医院2016年1月至2022年5月收治的8例电子结肠镜辅助经结肠NOSES患者的临床资料、手术方式、病理和随访结果。结果8例患者的肿瘤全部完整切除,标本在电子结肠镜的帮助下均顺利通过肠道经肛门取出,中位手术时间为190(160,210)min。中位术中出血量为60(40,80)mL。术后第一天中位VAS疼痛评分为4(2,5)分。术后病理获取的中位淋巴结数目为13(12,14)枚。1例患者术后第四天出现肺部感染,1例患者术后第六天出现肠梗阻,均经保守治疗后恢复,无吻合口漏及腹腔感染发生。术后随访6~50个月,无种植、复发及死亡发生。结论电子结肠镜辅助经结肠NOSES手术是一种安全、可靠、有效的手术方法,具有较好的应用前景和临床价值。

Objective We analyzed the clinical data of patients treated by colonoscope assisted transcolonic specimen extraction surgery,summarized the clinical treatment experience,and explored its clinical feasibility.Methods The clinical data,surgical methods,pathology,and follow-up results of 8 colonic neoplasm patients treated with transcolonic NOSES in the First Affiliated Hospital of Zhengzhou University from January 2016 to May 2022 were analyzed retrospectively.Results The tumors were completely resected in all 8 patients,and the specimens were successfully extracted through anus by colonoscope.The median operation time was 190(160,210)minutes.The median intraoperative blood loss was 60(40,80)mL.The median VAS pain score was 4(2,5)on the first day after operation.The median number of lymph nodes retrieved was 13(12,14).There was one case of pulmonary infection on the fourth day after operation,and one case of ileus on the sixth day after operation.Both recovered after conservative symptomatic treatment.No patient had anastomotic leakage and abdominal infection.Follow up for 6 to 50 months showed no implantation,recurrence,or death.Conclusion Colonoscope assisted transcolonic specimen extraction surgery is a safe,reliable and effective surgical method with excellent application prospects and clinical value.