3种经自然腔道取标本手术方式治疗直肠癌的安全性与肿瘤学预后对比研究

目的:探讨经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)的安全性,并比较3种取标术式在直肠癌治疗中的近期疗效和远期预后。方法:回顾性分析接受腹腔镜NOSES的Ⅰ~Ⅲ期直肠癌患者的临床资料。直肠NOSES手术包括外翻切除式、拉出切除式和切除拖出式3种。比较3种取标本方式的术后并发症、5年无病生存期(disease-free survival,DFS)、5年局部复发率(local recurrence rate,LRR)和5年远处转移率(distant metastasis rate,DMR)等指标。结果:本研究共有268例直肠癌患者符合入组标准,包括83例外翻切除式,75例拉出切除式,110例切除拖出式。肿瘤位置与手术方式的选择具有显著相关性,术后全部患者的并发症发生率为12.3%,其中外翻切除组为18.1%,高于拉出切除组(13.3%)和切除拖出组(7.3%),P=0.073。全部患者5年DFS、LRR及DMR分别是85.0%、4.2%和11.0%。切除拖出组患者5年DFS高于其他两组,外翻切除组患者5年LRR要高于其他两组,而5年DMR在外翻切除组中最低,差异均无统计学意义。结论:直肠癌NOSES 3种术式具有良好安全性和肿瘤学预后,肿瘤位置是选择手术方式的决定因素。

Safety and survival outcomes of transanal natural orifice specimen extraction using prolapsing technique for patients with middle-to low-rectal cancer

Objective:The transanal approach to specimen collection,combined with the prolapsing technique,is a wellestablished and minimally invasive surgery for treating rectal cancer.However,reports on outcomes for this approach are sparse.We compared short-and long-term outcomes of conventional laparoscopic surgery(CLS)vs.transanal natural orifice specimen extraction(NOSE)using the prolapsing technique for patients with middle-to low-rectal cancer.Methods:From January 2013 to December 2017,we enrolled consecutive patients with middle-to low-rectal cancer undergoing laparoscopic anterior resection.Totally,50 patients who underwent transanal NOSE using the prolapsing technique were matched with 50 patients who received CLS.Clinical parameters and survival outcomes between the two groups were compared.Results:Estimated blood loss(29.70±29.28 vs.52.80±45.09 mL,P=0.003),time to first flatus(2.50±0.79 vs.2.86±0.76,P=0.022),time to liquid diet(3.62±0.64 vs.4.20±0.76 d,P<0.001),and the need for analgesics(22%vs.48%,P=0.006)were significantly lower for the NOSE group compared to the CLS group.The incidences of overall complications and fecal incontinence were comparable in both groups.After a median follow-up of 44.52 months,the overall local recurrence rate(6%vs.5%,P=0.670),3-year disease-free survival(86.7%vs.88.0%,P=0.945)and 3-year overall survival(95.6%vs.96.0%,P=0.708),were not significantly different.Conclusions:For total laparoscopic rectal resection,transanal NOSE using the prolapsing technique is effective and safe,and associated with less trauma and pain,a faster recovery,and similar survival outcomes compared to CLS.

Estimation of Hammerstein nonlinear systems with noises using filtering and recursive approaches for industrial control

This paper discusses a strategy for estimating Hammerstein nonlinear systems in the presence of measurement noises for industrial control by applying filtering and recursive approaches.The proposed Hammerstein nonlinear systems are made up of a neural fuzzy network(NFN)and a linear state`-space model.The estimation of parameters for Hammerstein systems can be achieved by employing hybrid signals,which consist of step signals and random signals.First,based on the characteristic that step signals do not excite static nonlinear systems,that is,the intermediate variable of the Hammerstein system is a step signal with different amplitudes from the input,the unknown intermediate variables can be replaced by inputs,solving the problem of unmeasurable intermediate variable information.In the presence of step signals,the parameters of the state-space model are estimated using the recursive extended least squares(RELS)algorithm.Moreover,to effectively deal with the interference of measurement noises,a data filtering technique is introduced,and the filtering-based RELS is formulated for estimating the NFN by employing random signals.Finally,according to the structure of the Hammerstein system,the control system is designed by eliminating the nonlinear block so that the generated system is approximately equivalent to a linear system,and it can then be easily controlled by applying a linear controller.The effectiveness and feasibility of the developed identification and control strategy are demonstrated using two industrial simulation cases.

Preliminary surgical outcomes of laparoscopic right hemicolectomy with transrectal specimen extraction:a propensity score matching study of 120 cases(with video)

Background:Compared with conventional laparoscopic surgery,natural orifice specimen extraction surgery(NOSES)has many advantages.Laparoscopic right colectomy with transvaginal specimen extraction has been reported,but the safety and feasibility of transrectal specimen extraction in male patients with ascending colon cancer remain to be verified.This study aimed to preliminarily evaluate the feasibility and safety of laparoscopic right hemicolectomy with transrectal specimen extraction.Methods:The study was conducted at a single tertiary medical center in China.A total of 494 consecutive patients who underwent laparoscopic right colectomy between September 2018 and September 2020 were included.Transrectal specimen extraction was performed in 40 male patients(the NOSES group).Patients in the NOSES group were matched to the conventional laparoscopic group using propensity score matching at a 1:2 ratio.Short-term and long-term outcomes between the two groups were compared and evaluated.Results:Forty patients in the NOSES group and 80 patients in the conventional laparoscopic group were matched for analysis.Baseline characteristics were balanced after propensity matching.The operative features,including operating time,intraoperative bleeding,and the number of harvested lymph nodes,were statistically comparable in both groups.In terms of post-operative recovery,patients in the NOSES group showed preferable outcomes,as evidenced by less post-operative pain and faster return to flatus,defecation,and discharge.The post-operative complications rate,according to the Clavien–Dindo classification system,was similar in both groups.No differences in overall survival or disease-free survival were observed between the two groups.Conclusions:Laparoscopic right colectomy with transrectal specimen extraction is oncologically safe.Compared with conventional laparoscopic right colectomy,it can reduce post-operative pain,accelerate post-operative recovery,shorten the hospital stay,and achieve better cosmetic effect.

International guideline on natural orifice specimen extraction surgery(NOSES)for colorectal cancer(2023 version)

Purpose In recent years,natural orifice specimen extraction surgery(NOSES)has gained widespread attention as an alternative approach.Although the safety and feasibility of NOSES have been well documented,many questions remain open for discussion.The aim of this guideline is to provide more evidence for the promotion of NOSES.Methods This guideline has been prepared by the CACA Committee of Colorectal Cancer Society and the International NOSES Alliance,based on the latest evidence.Results The guideline on NOSES for colorectal cancer include the definition,classification,technology requirement,indications,technical difficulties and clinical research.Conclusion The guideline provides a full introduction of the theoretical and technical aspects of NOSES for colorectal cancer which will beneficial to development of NOSES.

经末段回肠系膜后隧道完成重叠式三角吻合的结肠脾曲癌完全腹腔镜左半结肠切除术23例临床分析

目的探讨采用经末段回肠系膜后隧道完成重叠式三角吻合的完全腹腔镜左半结肠切除术在结肠脾曲癌外科治疗中的可行性、安全性及近期疗效。方法回顾性收集中国医学科学院北京协和医学院肿瘤医院2018年1月至2022年1月收治的结肠脾曲癌患者中,行经末段回肠系膜后隧道完成重叠式三角吻合的完全腹腔镜左半结肠切除手术的23例患者临床和病理资料,统计并分析患者基线资料、手术情况、术后病理情况、术后恢复及围手术期并发症等数据。结果23例患者均成功施行经末段回肠系膜后隧道完成腔内吻合的完全腹腔镜左半结肠切除术。中位手术时间165 min,中位术中出血量为40 mL,中位切口长度为5.0 cm。手术标本肿瘤中位长径为4.3 cm,中位近端切缘为13.2 cm,中位远端切缘为12.1 cm,中位淋巴结检出数目为19枚。患者中位术后下地时间、进食时间、排气时间、排便时间与住院时间分别为17.5 h、12 h、33.5 h、55.5 h、5 d。随访30天内,1例患者出现腹腔感染,经抗感染保守治疗后好转。其余患者未出现切口感染、吻合口漏、腹腔出血、肠梗阻等并发症。结论经末段回肠系膜后隧道行完全腹腔镜下重叠式三角吻合可应用于结肠脾曲癌患者的外科治疗,安全可行,近期疗效满意,远期疗效待进一步随访观察。

诺蒎酮基喹唑啉-2-胺型铜离子荧光探针的合成及其应用研究

以可再生的b-蒎烯衍生物诺蒎酮为原料,设计合成了一种新型的诺蒎酮基喹唑啉-2-胺铜离子荧光探针N-苄基-4-(4-(二乙氨基)苯基)-7,7-二甲基-5,6,7,8-四氢-6,8-桥亚甲基喹唑啉-2-胺(BNQ).探针BNQ在PBS/THF(V/V=8/2,10mmol·L-1,pH=7.4)溶液中对Cu^(2+)表现出高度选择性的荧光猝灭效应,并能在较宽pH范围(4~10)内有效识别Cu^(2+).同时,荧光滴定实验结果表明,探针BNQ对Cu^(2+)具有良好的灵敏度,其检测限为0.09μmol·L^(-1),远低于世界卫生组织(WHO)规定在饮用水中Cu^(2+)的最高含量(<30μmol·L-1).而且,采用高分辨质谱以及密度泛函理论计算确定了探针BNQ与Cu^(2+)的络合作用机理.探针BNQ还可以对不同水环境中的微摩尔级Cu^(2+)进行快速检测.生物成像实验发现,探针BNQ还可检测斑马鱼体内的Cu^(2+),并呈现出良好的荧光成像效果.