摘要
目的对比腹腔镜经自然腔道取标本术(NOSES)与传统腹腔镜直肠低位前切除术的临床疗效,探究NOSES在直肠癌根治性切除中的安全性、有效性。方法回顾性分析2016年6月至2017年12月接受治疗的81例直肠癌患者资料,根据不同手术方式分为传统组49例行传统腹腔镜直肠低位前切除术,NOSES组32例行腹腔镜经自然腔道取标本术。采用统计软件SPSS20.0进行数据分析,围手术指标、氧化应激指标等采用均数±标准差表示,行独立t检验;并发症等行卡方检验;采用Kaplan-Meier法进行术后生存分析,P<0.05为差异有统计学意义。结果NOSES组首次下床时间及止痛药使用次数少于传统组(P<0.05)。两组术后并发症比较差异无统计学意义(P>0.05)。术后3 d两组丙二醛(MDA)水平升高,超氧化物歧化酶(SOD)水平降低,NOSES组升高/降低幅度小于传统组(P<0.05);术后3 d两组TNF-α、CRP、IL-6水平均增高,IL-10水平均降低,NOSES组水平优于传统组(P<0.05)。术后3个月,两组肛门功能评分差异无统计学意义(P>0.05)。术后1周两组生活自理能力评分均明显提高,NOSES组评分高于传统组(P<0.05)。术后1年传统组5例复发,生存率为89.8%;NOSES组2例复发,生存率为93.7%,两组近期生存率差异无统计学意义(P>0.05)。结论NOSES手术应用于直肠癌根治性切除中安全、可行、有效,恢复快、更微创,临床预后更好,值得在推广使用。
Objective To compare the clinical outcome of laparoscopic natural orifice specimen extraction surgery(NOSES)and traditional laparoscopic low anterior rectal resection,and to explored its safety and efficacy for rectal cancer.Methods From June 2016 to December 2017,clinical data of 81 patients with rectal cancers were analyzed retrospectively.According to the surgical methods,49 cases were divided into the traditional group who underwent traditional laparoscopic low rectal anterior resection,and 32 cases were divided into NOSES group.Statistical software SPSS20.0 were used for data analysis.Measurement data such as perioperative indicators and oxidative stress indicators were represented by mean standard deviation,and independent t test was performed.Chi-square test was performed for complications.Kaplan-meier method was used for postoperative survival analysis,and P<0.05 was considered statistically significant.Results The first ambulation time in NOSES group were significantly less than that in traditional group(P<0.05).There was no significant difference of postoperative complications between two groups(P>0.05).The levels of MDA increase and SOD decrease 3 days after surgery in NOSES group were significantly lower than those in traditional group(P<0.05).The levels of TNF-,CRP,IL-6 increase and IL-10 decrease 3 days after surgery in NOSES group were significantly higher than those in traditional group(P<0.05).On 3 months after surgery,there were no significant difference of anal function scores between two groups(P>0.05).One week after operation,the scores of self-care ability in the two groups were significantly improved,and the scores in the NOSES group were higher than those in the traditional group,with statistically significant difference(P<0.05).On one year after surgery,there were 5 cases of recurrence in traditional group with survival rate of 89.8%and 1 cases of recurrence in NOSES group with survival rate of 93.7%,with no statistically significant difference between two groups(P>0.05).Conclusion NOSES is safe,feasible,effective,rapid recovery mini-invasive,with a better prognosis than traditional laparoscopic anterior rectal resection,which is worth of popularizing.
作者
王小林
马任远
尹金祥
高庆东
张哲
Wang Xiaolin;Ma Renyuan;Yin Jinxiang;Gao Qingdong;Zhang Zhe(Department of General surgery,the 2nd hospital of Yulin city,Shanxi 719000,China)
出处
《中华普外科手术学杂志（电子版）》
2020年第1期50-53,共4页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
陕西省科技厅自然科学基础研究计划一般面上项目(2017JM8109)~~
关键词
直肠肿瘤
腹腔镜
NOSES
疗效比较研究
安全
Rectal neoplasms
Laparoscopes
NOSES
Comparative effectiveness research
Safety
