传统腹腔镜直肠癌根治术与NOSES对照研究

Comparative study of traditional laparoscopic radical resectionic of rectal cancer and NOSES

目的对比经自然腔道取标本手术(NOSES)与传统经辅助切口取标本手术的腹腔镜直肠癌根治术治疗效果。方法选择2019年7月~2022年7月于潍坊市人民医院结直肠肛门外科进行腹腔镜直肠前切除术的42例患者为研究对象,其中经直肠肛管取标本患者21例纳入观察组,肿瘤位置4~15cm、经腹壁辅助切口取标本且未预防性造口患者21例纳入对照组;对比两组手术时长、术中出血量、淋巴结清扫数量、手术标本情况以及术后患者恢复情况。结果两组患者术中出血量、标本近切缘、远切缘、淋巴结清扫数量、手术时长、开始进食时间、术后住院时间、手术并发症均无明显差异(P>0.05);观察组术后排气排便时间早于对照组,术后第1天CRP高于对照组,疼痛评分低于对照组(P<0.05)。结论NOSES与传统腹腔镜直肠癌手术的根治效果基本相同,且没有增加术后并发症发生和肿瘤转移的风险,其疼痛程度轻、腹部创伤小、排气排便早的优点使NOSES具有明显的优势。

Objective The study was conducted to retrospectively analyze the therapeutic effect of laparoscopic anterior rectal resection natural orifice specimen extraction and assisted incision extraction specimens.Methods From July 2019 to July 2022,rectal cancer patients adapted in Colorectal Anal Surgery Department of Weifang People's Hospital were retrospectively analyzed.Among them,the patients who received specimen extraction through anal canal without prophylactic fistula were included in the observation group(n=21).Patients with similar tumor position(4~15cm to Dentate line)undergoing laparoscopic anterior rectal excision without prophylactic fistula were selected as control group(n=21).The operation time,operational blood loss,lymphnode dissection,post-operative recovery and the postoperative complications were compared between two groups to discuss the problems encountered in the preliminary phase of NOSES and to prove the safety and feasibility of NOSES.Results There was no significant difference in intraoperative blood loss,perioperative margin,distal margin,lymphnode dissection times,operation time,food intake time,postoperative hospitalization time and complications between the two groups(P>0.05).There were significant differences in postoperative exhaust defecation time,VAS pain score and CRP on the first postoperative day(P<0.05).The postoperative exhaust defecation time in NOSES group was(2.81±0.749)d,(3.12±0.415)d in control group,CRP 53.020±18.897,26.275±15.672 in the first postoperative day,and the VAS pain score was 1.87±0.885,7.21±1.083 in the control group(P<0.05).Conclusion NOSES has the same radical effect as traditional laparoscopic rectal cancer surgery,without an increased risk of postoperative complications and tumor metastasis,NOSES has obvious advantages because of its advantages of light pain,less abdominal trauma and shortening the time of exhaust and defecation.