切除拖出式NOSES治疗结直肠癌的效果及其影响因素分析

Effect and Influencing Factors of Natural Orifice Specimen Extraction Surgery(NOSES)for Transanal Resec-tion in Treatment of Colorectal Cancer

目的:探讨分析切除拖出式经自然腔道取标本手术(NOSES)治疗结直肠癌患者的效果及影响因素。方法:将我院2019年4月至2023年2月收治的结直肠癌患者72例随机分为治疗A组和治疗B组,每组36例。治疗A组患者采用传统手术治疗,治疗B组患者采用切除拖出式NOSES治疗,观察并比较2组患者手术相关指标、术后并发症、炎症因子水平、肛门功能Kirwan分级及肛门疼痛评分,并根据多因素Logistics模型分析与经直肠取标本有关的临床因素。结果:治疗B组患者术后首次排气时间、住院时间均明显短于治疗A组(P<0.05),而2组患者术中出血量、手术时间比较无显著性差异(P>0.05);术后治疗B组患者发生腹盆腔感染、吻合口漏、尿潴留、创口感染、肠梗阻并发症发生率明显低于治疗A组(P<0.05);术前2组患者炎症因子水平比较差异无统计学意义(P>0.05),术后3 d 2组患者的炎症因子水平相较于术前均明显改善(P<0.05),且治疗B组明显低于治疗A组(P<0.05);术后治疗B组患者的肛门功能Kirwan分级情况显著优于治疗A组(P<0.05);术前2组患者肛门疼痛评分比较差异无统计学意义(P>0.05),术后2组患者的肛门疼痛评分相较于术前均明显改善(P<0.05),且治疗B组明显低于治疗A组(P<0.05);通过Logistic回归分析结果显示,体质指数≤25 kg/m^(2)、肿瘤距肛缘距离<5 cm、肿瘤最大直径≤5 cm以及直肠系膜前后径厚度≤6 cm均为经直肠取标本独立保护因素(P<0.05)。结论:相较于传统手术,切除拖出式NOSES治疗结直肠癌疗效显著,其术后首次排气时间和住院时间短,可有效降低术后并发症发生率和炎症因子水平,一定程度上缓解术后肛门疼痛,改善肛门功能,安全性良好,且体质指数、肿瘤距肛缘距离、肿瘤最大直径以及直肠系膜前后径厚度均为影响NOSES的重要临床因素。

Objective To explore and analyze the effect and influencing factors of natural orifice specimen extraction surgery(NOSES)for transanal resection in the treatment of patients with colorectal cancer.Methods Total 72patients with colorectal cancer admitted to our hospital from April 2019to February 2023were randomly divided into treatment group A and treatment group B,with 36cases in each group.The patients in treatment group A were treated with traditional surgical treatment,while the patients in treatment group B were treated with NOSES for transanal resection.The surgery-related indicators,postop-erative complications,levels of inflammatory factors,anal function Kirwan grading and anal pain scores of the two groups were observed and compared.The clinical factors related to transanal specimen extraction were analyzed according to the multivariate Logistics model.Results The first postoperative exhaust time and hospital stay of the patients in treatment group B were significantly shorter than those in treat-ment group A(P<0.05),while there was no significant difference in intraoperative blood loss and opera-tion time between the two groups(P>0.05).The incidence of abdominal and pelvic infection,anastomotic leakage,urinary retention,wound infection and intestinal obstruction of the patients in treatment group B was significantly lower than that of the patients in treatment group A(P<0.05).There was no significant difference in the levels of inflammatory factors between the two groups before operation(P>0.05),and the levels of inflammatory factors in the two groups were significantly improved 3days after operation(P<0.05),and the levels of inflammatory factors in treatment group B were significantly lower than those in treatment group A(P<0.05).The Kirwan classification of anal function of patients in treatment group B was significantly better than that of patients in treatment group A after operation(P<0.05).There was no significant difference in the anal pain score between the two groups before operation(P>0.05),and the anal pain scores in the two groups were significantly improved after operation(P<0.05),and the anal pain score in treatment group B was significantly lower than that in treatment group A(P<0.05).The re-sults of Logistic regression analysis showed that body mass index≤25kg/m^(2),the distance from tumor to anal edge<5cm,the maximum diameter of tumor≤5cm and the anteroposterior diameter thickness of mesorectum≤6cm were independent protective factors for transanal specimen extraction(P<0.05).Conclusion Compared with traditional surgery,the NOSES for transanal resection in the treatment of colorectal cancer has significant efficacy,and its first postoperative exhaust time and hospital stay are short,which can effectively reduce the incidence of postoperative complications and levels of inflammatory factors,relieve postoperative anal pain to a certain extent,improve anal function,and has good safety.The body mass index,the distance from tumor to anal edge,the maximum diameter of tumor and the anteropos-terior diameter thickness of mesorectum are important clinical influencing factors for NOSES.