腹部无辅助切口经直肠取标本的腹腔镜右半结肠癌根治术(NOSES Ⅷ式B法)的疗效分析(24例)

The efficacy analysis of laparoscopic right colon cancer radical resection transrectal specimen extraction without abdominal incision(NOSESⅧB)(24)cases

目的:探讨分析腹部无辅助切口经直肠取标本的腹腔镜右半结肠癌根治术(NOSESⅧ式B法)的安全性与临床疗效。方法:回顾性收集分析自2017年01月至2021年12月期间在中国医学科学院肿瘤医院与滦州市人民医院行腹部无辅助切口经阴道取标本的腹腔镜右半结肠癌根治术(NOSES式Ⅷ式A法)和NOSESⅧ式B法患者的临床病理资料。比较两组患者临床病理特征、手术结果、术后恢复、术后并发症、术后复发转移情况等。结果:共有81患者纳入研究,其中行NOSES式Ⅷ式A法患者共57例,行NOSES式Ⅷ式B法患者共24例。NOSES式Ⅷ式B法组男性患者比例显著高于NOSES式Ⅷ式A法组(91.7%vs 0,P<0.001)。两组患者其余基线资料无统计学差异(P>0.05)。两组患者平均手术时间[(176.6 vs 167.3)min,P=0.529]与术中出血量[(35.5 vs 31.2)mL,P=0.733]无明显统计学差异。两组患者术后第1天(4.3 vs 4.5,P=0.852)、第3天(4.0 vs 4.3,P=0.572)、第5天(2.5 vs 2.3,P=0.742)视觉模拟评分法(visual analogue scale,VAS)评分相似。两组患者在术后并发症方面无统计学差异(14.0%vs 12.5%,P=0.854)。两组患者术后首次排气时间[(2.0 vs 1.8)days,P=0.893]和术后住院时间[(7.0 vs 6.8)days,P=0.904]相似。术后病理方面,两组患者的淋巴结清扫数量[(24.6 vs 25.2)枚,P=0.319]、标本切除长度[(32.1 vs 33.2)cm,P=0.395]、肿瘤大小[(3.3 vs 2.8)cm,P=0.195]等方面无显著统计学差异。术后3个月内,NOSESⅧB组患者未出现与直肠切开相关并发症,如直肠流血、直肠狭窄、感觉异常、盆腔脓肿等。随访期间,NOSESⅧA组共有6例患者出现局部复发和远处转移,NOSESⅧB组共2例患者出现远处转移。两组患者均无切口、盆腔、直肠肠腔、阴道等标本取出途径肿瘤复发与转移。结论:NOSESⅧ式B法是安全可行的,亦具有创伤小、恢复快、疼痛轻等短期优势。在严格把握手术适应证和遵守无菌无瘤原则的前提下,该术式并不会增加肿瘤种植播散的风险,可以在年轻未婚女性患者或肿瘤位置高的男性结肠癌患者中应用。

Objective:To evaluate the safety and clinical efficacy of laparoscopic right colon cancer radical resection transrectal specimen extraction without abdominal incision(NOSESⅧtype B).Methods:From January 2017 to December 2021,the clinicopathological data of patients who underwent laparoscopic right colon cancer radical resection transvaginal specimen extraction without abdominal incision(NOSESⅧtype A)and NOSESⅧtype B in the Cancer Hospital of the Chinese Academy of Medical Sciences and Luanzhou People's Hospital were retrospectively collected and analyzed.The clinicopathological features,surgical conditions,postoperative recovery,postoperative complications,and postoperative recurrence and metastasis of the patients between two groups were compared.Results:A total of 81 patients were included in the study,including 57 patients who underwent NOSESⅧtype A and 24patients who underwent NOSESⅧtype B.The proportion of male patients in the NOSESⅧtype B group was significantly higher than that in the NOSESⅧtype A group(91.7%vs 0,P<0.001).There was no significant difference in the remaining baseline data between the two groups(P>0.05).There was no significant difference between the average operation time[(176.6 vs 167.3)min,P=0.529]and intraoperative blood loss[(35.5 vs 31.2)m L,P=0.733]between the two groups.In addition,the visual analogue scale(VAS)scores on day 1(4.3 vs 4.5,P=0.852),day 3(4.0 vs 4.3,P=0.572)and day 5(2.5 vs 2.3,P=0.742)were similar between the two groups.There was no significant difference in postoperative complications between the two groups(14.0%vs 12.5%,P=0.854).The time to first flatus[(2.0 vs 1.8)days,P=0.893]and postoperative hospital stay[(7.0 vs 6.8)days,P=0.904]were similar between the two groups.In terms of pathology,there were no significant differences in the number of lymph nodes dissected[(24.6 vs 25.2)number,P=0.319],specimen resection length[(32.1 vs 33.2)cm,P=0.395],and tumor size[(3.3 vs 2.8)cm,P=0.195]between the two groups.Within 3 months after surgery,patients in the NOSESⅧtype B group did not have complications related to rectotomy,such as rectal bleeding,rectal stricture,paresthesias,and pelvic abscess.During the follow-up period,a total of 6 patients in the NOSESⅧtype A group had local recurrence and distant metastasis,and a total of 2 patients in the NOSESⅧtype B group had distant metastases.In both groups,tumor recurrence and metastasis were not found in incision pelvic,rectal cavity and vagina.Conclusion:Laparoscopic right colon cancer radical resection transrectal specimen extraction without abdominal incision is safe and feasible,with short term advantages such as less trauma,faster recovery and less pain.Under the premise of strictly grasping the surgical indications and adhering to the principle of sterile tumor-free,this procedure does not increase the risk of tumor recurrence implantation,and can be carried out in young unmarried female patients or in male colon cancer patients with high tumor location.