NOSES与传统腹腔镜手术对直肠癌根治术患者胃肠功能恢复及炎症反应的影响对比

Comparison of the Effects of NOSES and Traditional Laparoscopic Surgery on Gastrointestinal Functional Recovery and Inflammatory Response in Patients with Radical Resection of Rectal Cancer

目的:分析比较经自然腔道取标本手术(NOSES)与传统腹腔镜手术对直肠癌根治术患者胃肠功能恢复及炎症反应的影响。方法:选取2021年3月—2023年7月于广东省人民医院赣州医院普外科行直肠癌根治术的96例患者作为研究对象。将行传统腹腔镜手术的患者纳入为对照组,将行NOSES的患者纳入研究组,各48例。比较两组手术相关指标、术后康复指标、胃肠功能指标、免疫应激指标及炎症因子。结果:研究组肛门通气时间、肠鸣恢复时间、胃肠蠕动时间均早于对照组,手术时间、住院时间均短于对照组,术中失血量少于对照组,并发症总发生率低于对照组,差异均有统计学意义(P<0.05);两组淋巴结清除数量比较,差异无统计学意义(P>0.05)。术后3 d,两组胃动素、胃泌素含量均低于术前,且研究组均低于对照组,差异均有统计学意义(P<0.05)。术后3 d,两组丙二醛(MDA)水平均显著高于术前,超氧化物歧化酶(SOD)水平均低于术前,但研究组MDA水平低于对照组,SOD水平高于对照组,差异均有统计学意义(P<0.05)。术后3 d,两组白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)均低于术前,高迁移率族蛋白B1(HMGB1)均高于术前,且研究组IL-6、TNF-α、HMGB1均低于对照组,差异均有统计学意义(P<0.05)。结论:相较于传统腹腔镜手术,NOSES可更有效地促进直肠癌根治术患者胃肠功能恢复,降低炎症反应,减少术后并发症。

Objective:To analyze and compare the effects of natural orifice specimen extraction surgery(NOSES)and traditional laparoscopic surgery on gastrointestinal functional recovery and inflammatory response after radical resection of rectal cancer.Method:A total of 96 patients who underwent radical resection of rectal cancer in the Department of General Surgery of Guangdong Provincial People's Hospital Ganzhou Hospital from March 2021 to July 2023 were selected as the study objects.Patients who had undergone traditional laparoscopic surgery were included in the control group,and the NOSES patients were included in the study group,48 patients each.surgery related indexes,postoperative rehabilitation indexes,gastrointestinal function indexes,immune stress indexes and inflammatory factors were compared between the two groups.Result:The anal ventilation time,bowel singing recovery time,gastrointestinal peristalsis time in the study group were earlier than those in control group,and surgery time,hospital stay of the study group were shorter than those of the control group,the intraoperative blood loss was less than that of the control group,and the total incidence of complications was lower than that of the control group,the differences were statistically significant(P<0.05).There was no significant difference in the number of lymph node clearance between the two groups(P>0.05).3 d after surgery,the contents of motilin and gastrin in two groups were lower than those before surgery,and those in the study group were lower than those in the control group,the differences were statistically significant(P<0.05).3 d after surgery,the levels of malondialdehyde(MDA)and superoxide dismutase(SOD)in two groups were significantly higher than those before surgery,but the level of MDA in the study group was lower than that in the control group,and the level of SOD was higher than that in the control group,the differences were statistically significant(P<0.05).3 d after surgery,interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in two groups were lower than those before surgery,and high mobility group protein B1(HMGB1)were higher than those before surgery,and IL-6,TNF-αand HMGB1 in the study group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Compared with traditional laparoscopic surgery,NOSES is more effective in promoting gastrointestinal function recovery,reducing inflammatory response,and reducing postoperative complications in patients with radical rectal cancer surgery.