抵钉座体外置入法经肛门外翻切除标本腹部无辅助切口腹腔镜低位直肠癌根治术的近期疗效
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摘要
目的探讨抵钉座体外置入法在经肛门外翻切除标本的腹部无辅助切口腹腔镜低位直肠癌根治术中的近期疗效及应用价值。方法回顾性分析2015年6月至2018年6月在河南大学淮河医院肛肠外科接受腹腔镜低位直肠癌根治术的52例患者的临床资料,其中26例行抵钉座体外置入法经肛门外翻切除标本的腹部无辅助切口手术(NOSES组),26例行传统腹壁小切口取标本手术(LAP组)。并对其术中、术后资料进行分析。结果两组共52例患者手术均顺利完成,无中转开腹病例,两组患者手术时间、术中出血量、淋巴结清扫数目、术后并发症发生率、环周切缘情况、术后随访情况及术后肛门功能比较,差异均无统计学意义(均P>0.05)。与LAP组相比,NOSES组术后胃肠道功能恢复时间、术后住院时间均更短,术后疼痛评分、额外镇痛药物使用率更低,住院费用更少,患者对术后腹壁外观满意程度更高(均P<0.05)。结论抵钉座体外置入法经肛门外翻切除标本的腹部无辅助切口腹腔镜低位直肠癌根治术近期疗效满意,且在减轻术后疼痛、缩短术后住院时间、降低住院费用、腹壁外观更加美观等方面具有优势。
Objective To study the short-term outcomes and value of natural orifice specimen extraction surgery for low rectal cancer using a prolapsing technique.Methods From Jun 2015 to Jun 2018, 52 patients with low rectal cancer were divided into natural orifice specimen extraction surgery group(NOSES group, 26 cases) and laparoscopic low anterior resection group(LAP group, 26 cases).Results There were no significant differences on the operation time, intraoperative blood loss, lymph node dissection, postoperative complication rate, circumferential margin, postoperative follow-up and postoperative anal function between the two groups(all P>0.05). Compared with the LAP group, the patients in NOSES group had shorter gastrointestinal function recovery time and length of stay, lower postoperative pain score, lower analgesic drug use rate, lower hospitalization cost, and better cosmetic results(all P<0.05).Conclusions The short-term efficacy of patients in NOSES group is satisfactory, which has the advantages of recovery enhancement and expenditure.
Objective To study the short-term outcomes and value of natural orifice specimen extraction surgery for low rectal cancer using a prolapsing technique.Methods From Jun 2015 to Jun 2018, 52 patients with low rectal cancer were divided into natural orifice specimen extraction surgery group(NOSES group, 26 cases) and laparoscopic low anterior resection group(LAP group, 26 cases).Results There were no significant differences on the operation time, intraoperative blood loss, lymph node dissection, postoperative complication rate, circumferential margin, postoperative follow-up and postoperative anal function between the two groups(all P>0.05). Compared with the LAP group, the patients in NOSES group had shorter gastrointestinal function recovery time and length of stay, lower postoperative pain score, lower analgesic drug use rate, lower hospitalization cost, and better cosmetic results(all P<0.05).Conclusions The short-term efficacy of patients in NOSES group is satisfactory, which has the advantages of recovery enhancement and expenditure.
引文
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[10] 李兴旺, 陈河金, 李柄辉, 等. 改良抵钉座体外置入法在经肛门外翻切除标本腹部无辅助切口腹腔镜低位直肠癌根治术中的应用[J].中华胃肠外科杂志,2018,21(8):913-917.
[11] 中国NOSES联盟,中国医师协会结直肠肿瘤专业委员会NOSES专委会. 结直肠肿瘤经自然腔道取标本手术专家共识(2017)[J/CD]. 中华结直肠疾病电子杂志, 2017, 6(4): 266-272.
[12] Juul T, Ahlberg M, Biondo S, et al. International validation of the low anterior resection syndrome score[J]. Ann Surg, 2014, 259(4):728-734.
[13] Fishman B, Pasternak S, Wallenstein SL, et al. The Memorial Pain Assessment Card. A valid instrument for the evaluation of cancer pain[J]. Cancer, 1987, 60(5):1151-1158.
[14] Kearney DE, Coffey JC. A randomized trial of laparoscopic versus open surgery for rectal cancer[J]. N Engl J Med. 2015,9;373(2):194.
[15] Deijen CL, Vasmel JE, de Lange-de Klerk ESM, et al. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer[J]. Surg Endosc, 2017,31(6):2607-2615.
[16] 王建军.全直肠系膜切除术对直肠癌患者局部复发率及生活质量的影响[J]. 中国肿瘤外科杂志,2016,8 (3): 188-189.
[17] Alam AH, Soyer V, Sabuncuoglu MZ, et al. Natural orifice specimen extraction (NOSE) and transanal extracorporeal anvil placement during laparoscopic low anterior resection[J]. Tech Coloproctol. 2014, 18(7):669-671.
[18] Asari SA, Cho MS, Kim NK. Safe anastomosis in laparoscopic and robotic low anterior resection for rectal cancer: a narrative review and outcomes study from an expert tertiary center[J]. Eur J Surg Oncol, 2015,41(2):175-185.
[19] Baek SJ, Kim J, Kwak J, et al. Can trans-anal reinforcing sutures after double stapling in lower anterior resection reduce the need for a temporary diverting ostomy?[J]. World J Gastroenterol, 2013,19(32):5309-5313.
[20] Lamm SH, Zerz A, Efeoglou A, et al. Transrectal Rigid-Hybrid Natural Orifice Translumenal Endoscopic Sigmoidectomy for Diverticular Disease: A Prospective Cohort Study[J]. J Am Coll Surg, 2015,221(4):789-797.
[21] Sylla P, Rattner DW, Delgado S, et al. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance[J]. Surg Endosc, 2010,24(5):1205-1210.
[22] JRT M, Arsalanizadeh R. Transanal Total Mesorectal Excision (TaTME) and Quality of Rectal Cancer Surgery: Do we Really Know?[J]. Ann Surg, 2017,266(6):e88-e89.
[23] Penna M, Hompes R, Arnold S, et al. Incidence and Risk Factors for Anastomotic Failure in 1594 Patients Treated by Transanal Total Mesorectal Excision: Results From the International TaTME Registry[J]. Ann Surg, 2018. doi: 10.1097/SLA.0000000000002653.
[24] Deijen CL, Velthuis S, Tsai A, et al. COLOR Ⅲ: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer[J]. Surg Endosc, 2016,30(8):3210-3215.
[25] 康亮. 如何规范开展经肛全直肠系膜切除术[J]. 中华胃肠外科杂志, 2017, 20(8):862-864.
[2] van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial[J]. Lancet Oncol, 2013,14(3):210-218.
[3] Hisada M, Katsumata K, Ishizaki T, et al. Complete laparoscopic resection of the rectum using natural orifice specimen extraction[J]. World J Gastroenterol, 2014,20(44):16707-16713.
[4] Blackmore AE, Wong MT, Tang CL. Evolution of laparoscopy in colorectal surgery:An evidencebased review[J]. World J Gastroenterol. 2014,20(17):4926-4933.
[5] 王锡山. 结直肠肿瘤类-NOTES 术之现状及展望[J].中华结直肠疾病电子杂志,2015,4(4):11-16.
[6] 王锡山.经自然腔道取标本手术—结直肠肿瘤[M].北京:人民卫生出版社,2016.
[7] 王锡山.经自然腔道取标本手术学—胃肠肿瘤[M].2版,北京:人民卫生出版社,2018.
[8] Xishan Wang. Natural Orifice Specimen Extraction Surgery—Colorectal Cancer[M]. Berlin:Springer,2018.
[9] 姜争,陈瑛罡,王锡山,等.腹部无切口经直肠肛门外翻切除标本的腹腔镜低位直肠癌根治术[J].中华胃肠外科杂志,2014,17(5):499-501.
[10] 李兴旺, 陈河金, 李柄辉, 等. 改良抵钉座体外置入法在经肛门外翻切除标本腹部无辅助切口腹腔镜低位直肠癌根治术中的应用[J].中华胃肠外科杂志,2018,21(8):913-917.
[11] 中国NOSES联盟,中国医师协会结直肠肿瘤专业委员会NOSES专委会. 结直肠肿瘤经自然腔道取标本手术专家共识(2017)[J/CD]. 中华结直肠疾病电子杂志, 2017, 6(4): 266-272.
[12] Juul T, Ahlberg M, Biondo S, et al. International validation of the low anterior resection syndrome score[J]. Ann Surg, 2014, 259(4):728-734.
[13] Fishman B, Pasternak S, Wallenstein SL, et al. The Memorial Pain Assessment Card. A valid instrument for the evaluation of cancer pain[J]. Cancer, 1987, 60(5):1151-1158.
[14] Kearney DE, Coffey JC. A randomized trial of laparoscopic versus open surgery for rectal cancer[J]. N Engl J Med. 2015,9;373(2):194.
[15] Deijen CL, Vasmel JE, de Lange-de Klerk ESM, et al. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer[J]. Surg Endosc, 2017,31(6):2607-2615.
[16] 王建军.全直肠系膜切除术对直肠癌患者局部复发率及生活质量的影响[J]. 中国肿瘤外科杂志,2016,8 (3): 188-189.
[17] Alam AH, Soyer V, Sabuncuoglu MZ, et al. Natural orifice specimen extraction (NOSE) and transanal extracorporeal anvil placement during laparoscopic low anterior resection[J]. Tech Coloproctol. 2014, 18(7):669-671.
[18] Asari SA, Cho MS, Kim NK. Safe anastomosis in laparoscopic and robotic low anterior resection for rectal cancer: a narrative review and outcomes study from an expert tertiary center[J]. Eur J Surg Oncol, 2015,41(2):175-185.
[19] Baek SJ, Kim J, Kwak J, et al. Can trans-anal reinforcing sutures after double stapling in lower anterior resection reduce the need for a temporary diverting ostomy?[J]. World J Gastroenterol, 2013,19(32):5309-5313.
[20] Lamm SH, Zerz A, Efeoglou A, et al. Transrectal Rigid-Hybrid Natural Orifice Translumenal Endoscopic Sigmoidectomy for Diverticular Disease: A Prospective Cohort Study[J]. J Am Coll Surg, 2015,221(4):789-797.
[21] Sylla P, Rattner DW, Delgado S, et al. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance[J]. Surg Endosc, 2010,24(5):1205-1210.
[22] JRT M, Arsalanizadeh R. Transanal Total Mesorectal Excision (TaTME) and Quality of Rectal Cancer Surgery: Do we Really Know?[J]. Ann Surg, 2017,266(6):e88-e89.
[23] Penna M, Hompes R, Arnold S, et al. Incidence and Risk Factors for Anastomotic Failure in 1594 Patients Treated by Transanal Total Mesorectal Excision: Results From the International TaTME Registry[J]. Ann Surg, 2018. doi: 10.1097/SLA.0000000000002653.
[24] Deijen CL, Velthuis S, Tsai A, et al. COLOR Ⅲ: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer[J]. Surg Endosc, 2016,30(8):3210-3215.
[25] 康亮. 如何规范开展经肛全直肠系膜切除术[J]. 中华胃肠外科杂志, 2017, 20(8):862-864.