经鼻插入肠梗阻导管联合NOSES微创治疗梗阻性结直肠癌的研究

The clinical study of transnasal ileus tube combined with NOSES in the treatment of obstructive colorectal cancer

目的观察经鼻插入肠梗阻导管联合经自然腔道取标本手术(NOSES)对梗阻性结直肠癌(OCRC)的临床治疗效果.方法前瞻性收集中国人民解放军联勤保障部队第九八八医院普通外科2021年6月至2023年8月OCRC 46例患者的临床资料,观察组23例应用经鼻插入型肠梗阻导管联合NOSES手术治疗,对照组23例应用肠道支架联合腹腔镜手术治疗,对比两组围术期相关指标,分析对OCRC的治疗效果.结果观察组23例完成肠梗阻导管置入,对照组21例完成支架置入,观察组置入成功率(100%vs.91.3%)虽高于对照组,但差异无统计学意义(x2=0.523,P=0.470).其中观察组2例无效,对照组1例无效,两组缓解率(91.3%vs.95.2%)的差异无统计学意义(x2=0,P=1.000).观察组在肠梗阻导管置入的操作时间(t=-8.064,P<0.001)及植入后并发症(P=0.044)方面要优于对照组.在症状缓解时间(t=4.530,P<0.001)及排气/排便时间(t=14.115,P<0.001)方面观察组劣于对照组.观察组3例术中改行传统腹腔镜手术,其中1例加做预防性回肠造口,余18例顺利完成NOSES手术,NOSES手术完成率85.7%;对照组19例均完成腹腔镜手术,手术完成率100%,其中6例加做预防性回肠造口,两组Ⅰ期吻合率均为100%.在术前准备时间(t=-4.559,P<0.001)、造口率(P=0.040)、术后首次排气时间(t=-3.833,P=0.001)、术后住院时间(t=-2.049,P=0.048)和住院费用(t=-4.787,P<0.001)方面观察组要优于对照组.在手术时间(t=-1.682,P=0.105)、出血量(t=-1.815,P=0.078)、淋巴结清扫数目(t=-1.890,P=0.070)、术后并发症(x2=0.223,P=0.637)方面两组差异无统计学意义.结论经鼻插入型肠梗阻导管能有效缓解OCRC症状,避免支架弊端,同时联合NOSES手术是安全的,使OCRC的治疗更加经济、微创.

Objective To observe the clinical effect of transnasal ileus tube combined with natural orifice specimen extraction surgery(NOSES)in the treatment of obstructive colorectal cancer(OCRC).Methods A total of 46 OCRC patients were prospectively collected at the Department of General Surgery,No.988 Hospital of the Joint Logistic Support Force of the Chinese from June 2021 to August 2023.Twenty-three cases in the observation group were treated with transnasal ileus tube combined with NOSES,while 23 cases in the control group were treated with intestinal stent combined with laparoscopic surgery.To describe the operation process of transnasal ileus tube,compare the perioperative data of the two groups and analyze the treatment effects of OCRC.Results The observation group were successfully implanted in all 23 patients and 21 cases in the control group were completed.The technical success rate(100%vs.91.3%)was higher than that of control group,but there was no significant difference(χ2=0.523,P=0.470).Two cases were ineffective in the observation groups and 1 case in the control group.The remission rate(91.3%vs.95.2%)was no difference between the two groups(χ2=0,P=1.000).The observation group was superior to the control group in operating time(t=-8.064,P<0.001)and complications(P=0.044).The observation group was inferior to the control group in terms of remission time(t=4.530,P<0.001)and exhaust or defecation time(t=14.115,P<0.001).Three cases in the observation group underwent traditional laparoscopic surgery,including 1 case with ileostomy,and the other 18 cases successfully completed NOSES operations.The completion rate of NOSES was 85.7%.all nineteen cases in the control group completed laparoscopic surgery,including 6 cases with ileostomy.The completion rate of laparoscopic surgery was 100%.The rate of primary anastomosis was 100%in the both groups.The observation group was superior to the control group in preoperative preparation time(t=-4.559,P<0.001),ostomy rate(P=0.040),first exhaust time(t=-3.833,P=0.001),postoperative hospitalization time(t=-2.049,P=0.048)and hospitalization expense(t=-4.787,P<0.001).There were no differences in operation time(t=-1.682,P=0.105),bleeding volume(t=-1.815,P=0.078),number of lymph node dissection(t=-1.890,P=0.070)and postoperative complications(χ2=0.223,P=0.637).Conclusion The transnasal ileus tube can significantly relieve obstruction symptoms,and avoid intestinal stent defects.It is safe to combine with NOSES and making the treatment of OCRC more economical and minimally invasive.