三孔腹腔镜下经自然腔道取标本术在直肠癌患者中的应用价值

Application value of triple-hole laparoscopy through natural duct in patients with rectal cancer

目的探究三孔腹腔镜下经自然腔道取标本术(NOSES)在直肠癌患者中的应用价值。方法选取直肠癌患者78例,依据随机数字表法将患者均分为对照组和观察组,对照组予以传统腹腔镜直肠癌根治术治疗,观察组予以三孔NOSES直肠癌根治术;比较两组患者治疗后手术时间、术中出血量、术后下床时间与排气时间、淋巴结清扫量及住院时间等手术相关指标;于术后2、12、24 h时采用视觉模拟评分法(VAS)评估两组患者疼痛情况;于术前1 d及术后24 h时通过酶联免疫吸附法检测患者去甲肾上腺素(NE)、白细胞介素-6(IL-6)、皮质醇(COR),采用酶联免疫吸附法(ELISA)测定患者免疫球蛋白G(IgG)、免疫球蛋白M(IgM)及免疫球蛋白A(IgA)水平;于术后通过肛门形态学评分评估患者肛门形态,检测患者肛管最大静息压与收缩压,通过肛门形态学评分评估肛门失禁情况,并记录2组患者术后吻合口出血、吻合口漏、尿潴留、切口感染、切口疝、肠梗阻、泌尿感染等并发症发生情况。结果与对照组比较,观察组手术时间增加,且术中出血量、术后下床时间、术后排气时间及住院时间均短于对照组,差异有统计学意义(P<0.05);两组患者术后同时点评分比较,观察组低于对照组,2、12、24 h时VAS评分比较,2 h>12 h>24 h,差异有统计学意义(P<0.05);与治疗前比较,2组患者治疗后NE、IL-6及COR水平均降低,且观察组低于对照组,差异有统计学意义(P<0.05);与术前1 d比较,两组患者术后24 h时IgG、IgM、IgA均显著降低,且观察组低于对照组,差异有统计学意义(P<0.05);两组术后肛门最大收缩压、肛门静息压、肛门形态学评分及肛门失禁评分,并发症发生率比较,差异均无统计学意义(P>0.05)。结论三孔NOSES直肠癌根治术治疗患者术后康复较快,微创性更高,应激反应相对更轻,安全性良好。

Objective To investigate the value of triple-hole NOSES in patients with rectal cancer.Methods A total of 78 patients with rectal cancer were randomly divided into control group and observation group with equal number in each group.The control group was treated with traditional laparoscopic radical resection of rectal cancer,while the observation group was treated with triple-hole NOSES radical resection.The surgical indexes were compared between two groups,including post-treatment surgery time,intraoperative blood loss,postoperative leaving bed time,postoperative exhaust time,lymph node cleaning amount and hospital stay.2,12,and 24 h postoperative Visual Analogue Scale(VAS)were adopted to evaluate pain condition of both groups;norepinephrine(NE),interleukin-6(IL-6),cortisol(COR)were detected by ELISA 1 day before surgery and 24 h after surgery;ELISA was also adopted to detect immunoglobulin G(IgG),immunoglobulin M(IgM),immunoglobulin A(IgA).Anal form was evaluated by anal morphology after surgery;maximum resting pressure and systolic pressure of anal tube were detected.Fecal incontinence was evaluated by anal morphology scale.Complications were recorded,including post-operative anastomosis bleeding,anastomotic leakage,urinary retention,incision infection,incision hernia,intestinal obstruction,urinary infection.Results Compared with the control group,the operation time in the observation group was significantly increased;in addition,the intraoperative blood loss,postoperative leaving bed time,postoperative exhaust time and hospital stay were significantly decreased in observation group,differences were statistically significant(P<0.05).Compared with same time points of both groups after surgery,that of observation group was lower than control group(P<0.05);VAS scores comparison of 2,12,24 h,2 h>12 h>24 h,differences were statistically significant(P<0.05).Compared with before treatment,the levels of NE,IL-6,and COR in the observation group were significantly lower than the control group,differences were statistically significant(P<0.05).Compared with before treatment,after surgery,the IgG,IgM,and IgA levels in both groups were significantly reduced,and compared with the control group,the observation group was significantly lower,differences were statistically significant(P<0.05).There was no statistically significant differences between both groups in terms of postoperative maximum anal systolic pressure,anal resting pressure,anal morphology score,anal incontinence score,and the incidence of complications(P>0.05).Conclusion Triple-hole NOSES radical resection of rectal cancer is conducive to the patients'postoperative recovery,with little micro-invasion,milder stress response,and high safety.