NOSES技术在结直肠肿瘤手术中的应用体会
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摘要
目的评价在结直肠肿瘤切除术中应用经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)的安全性及可行性。方法回顾性分析江苏省苏北人民医院自2016年7月至2018年4月实施的10例NOSES结直肠肿瘤手术的患者资料。结果 10例患者顺利完成NOSES结直肠肿瘤切除术,无中转开腹或经腹部辅助切口取出标本,平均手术时间(161±42.4)min,平均术中出血量(29±27.2)ml,平均清扫淋巴结(12.3±3.2)枚,平均术后排气时间(2.8±0.9)d,平均术后住院时间(11±2.3)d。其中1例患者术后出现吻合口瘘,行回肠造口治疗后好转;其余患者未见并发症。结论 NOSES技术在结直肠肿瘤手术中是安全、可行的。
Objective To analyze the natural orifice specimen extraction surgery′s safety and feasibility in colorectal tumor surgery. Methods A retrospective analysis of 10 patients with natural orifice specimen extraction surgery(NOSES)performed by Northern Jiangsu Province Hospital from Jul. 2016 to Apr. 2018. Results Ten patients completed the natural orifice specimen extraction surgery successfully, and all patients avoided auxiliary incision or sampling through abdominal auxiliary incision. The average operation time was(161±42.4) min, the average intraoperative bleeding volume was(29±27.2) ml, the average number of lymph nodes was(12.3±3.2), the average postoperative exhaust time was(2.8±0.9)d, and the average postoperative discharge time was(11±2.3)d. Anastomotic fistula appeared in one patient, and recovered after ileostomy. Conclusions In colorectal cancer surgery,the NOSES technology was feasible and safe.
Objective To analyze the natural orifice specimen extraction surgery′s safety and feasibility in colorectal tumor surgery. Methods A retrospective analysis of 10 patients with natural orifice specimen extraction surgery(NOSES)performed by Northern Jiangsu Province Hospital from Jul. 2016 to Apr. 2018. Results Ten patients completed the natural orifice specimen extraction surgery successfully, and all patients avoided auxiliary incision or sampling through abdominal auxiliary incision. The average operation time was(161±42.4) min, the average intraoperative bleeding volume was(29±27.2) ml, the average number of lymph nodes was(12.3±3.2), the average postoperative exhaust time was(2.8±0.9)d, and the average postoperative discharge time was(11±2.3)d. Anastomotic fistula appeared in one patient, and recovered after ileostomy. Conclusions In colorectal cancer surgery,the NOSES technology was feasible and safe.
引文
1 Wolthuis AM,Overstraeten ADBV,André d′hoore.Laparoscopic natural orifice specimen extraction- colectomy:a systematic review[J].World Journal of Gastroenterology,2014,20(36):12981- 12992.
2 Kalloo AN,Singh VK,Jagannath SB,et al.Flexible transgastric peritoneoscopy:a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity[J].Gastrointestinal Endoscopy,2004,60(1):114- 117.
3 Sylla P,Rattner DW,Delgado S,et al.NOTES teansanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance[J].Surg Endosc,2010,24(5):1205- 1210.
4 王锡山,崔滨滨,刘正,等.经阴道入路直肠肿瘤切除术二例[J].中华胃肠外科杂志,2011,14(5):325- 326.
5 Musquera M,Peri L,Izquierdo L,et al.Is LESS/NOTES surgery the new gold standard of minimally invasive surgery[J].Archivos Espa?oles De Urología,2013,66(1):161- 167.
6 朱渝军,陈刚,胡佳,等.腹腔镜与开腹手术治疗结直肠癌的临床疗效及术后并发症的比较[J].实用癌症杂志,2016,31(1):103- 106.
7 王锡山.结直肠肿瘤类- NOTES术之现状及展望[J/CD].中华结直肠疾病电子杂志,2015,4(4):11- 16.
8 王锡山.结直肠肿瘤治疗的微创和功能外科理念在实践与探索中前行[J/CD].中华结直肠疾病电子杂志,2013,2(3):9- 11.
9 Xingmao Z,Haitao Z,Jianwei L,et al.Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic- assisted resection for selected patients with sigmoid colon or rectal cancer[J].International Journal of Colorectal Disease,2014,29(9):1119- 1124.
10 李杰,李禹呈,郑阳春,等,腹腔镜下结直肠癌体内切除标本经直肠拖出手术(NOSES)的无菌和无瘤操作技巧[J/CD].中华腔镜外科杂志(电子版),2018,11(6):360- 363.
11 段吉清,所剑,孙东辉.两步翻出法在低位直肠癌NOSES中的五例应用[J/CD].中华腔镜外科杂志(电子版),2018,11(4):247- 247.
12 关旭,王贵玉,周主青,等.79家医院718例结直肠肿瘤经自然腔道取标本手术回顾性研究[J/CD].中华结直肠疾病电子杂志,2017,6(6):469- 477.
13 Saurabh B,Chang SC,Ke TW,et al.Natural orifice specimen extraction with single stapling colorectal anastomosis for laparoscopic anterior resection:feasibility,outcomes,and technical considerations[J].Diseases of the Colon & Rectum,2017,60(1):43- 45.
14 Ersin G,Aydin A,Cuneyt K,et al.Two cases of laparoscopic total colectomy with natural orifice specimen extraction and review of the literature[J].Videosurgery and Other Miniinvasive Techniques,2017,12(3):291- 296.
15 Jr MEF,Russek K.Natural orifice specimen extraction in laparoscopic colorectal surgery:transanal and transvaginal approaches[J].Techniques in Coloproctology,2013,17(1):63- 67.
16 Denost Q,Adam JP,Pontallier A,et al.Laparoscopic total mesorectal excision with coloanal anastomosis for rectal cancer[J].Annals of Surgery,2015,261(1):138- 143.
17 Wolthuis AM,Fieuws S,Van DBA,et al.Randomized clinical trial of laparoscopic colectomy with or without natural- orifice specimen extraction[J].British Journal of Surgery,2015,102(6):630- 637.
18 Cai JC,Hong XY.Laparoscopic- assisted natural orifice specimen extraction radical descending colectomy using a cai tube[J].World Journal of Surgery,2016,40(11):2803- 2807.
2 Kalloo AN,Singh VK,Jagannath SB,et al.Flexible transgastric peritoneoscopy:a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity[J].Gastrointestinal Endoscopy,2004,60(1):114- 117.
3 Sylla P,Rattner DW,Delgado S,et al.NOTES teansanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance[J].Surg Endosc,2010,24(5):1205- 1210.
4 王锡山,崔滨滨,刘正,等.经阴道入路直肠肿瘤切除术二例[J].中华胃肠外科杂志,2011,14(5):325- 326.
5 Musquera M,Peri L,Izquierdo L,et al.Is LESS/NOTES surgery the new gold standard of minimally invasive surgery[J].Archivos Espa?oles De Urología,2013,66(1):161- 167.
6 朱渝军,陈刚,胡佳,等.腹腔镜与开腹手术治疗结直肠癌的临床疗效及术后并发症的比较[J].实用癌症杂志,2016,31(1):103- 106.
7 王锡山.结直肠肿瘤类- NOTES术之现状及展望[J/CD].中华结直肠疾病电子杂志,2015,4(4):11- 16.
8 王锡山.结直肠肿瘤治疗的微创和功能外科理念在实践与探索中前行[J/CD].中华结直肠疾病电子杂志,2013,2(3):9- 11.
9 Xingmao Z,Haitao Z,Jianwei L,et al.Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic- assisted resection for selected patients with sigmoid colon or rectal cancer[J].International Journal of Colorectal Disease,2014,29(9):1119- 1124.
10 李杰,李禹呈,郑阳春,等,腹腔镜下结直肠癌体内切除标本经直肠拖出手术(NOSES)的无菌和无瘤操作技巧[J/CD].中华腔镜外科杂志(电子版),2018,11(6):360- 363.
11 段吉清,所剑,孙东辉.两步翻出法在低位直肠癌NOSES中的五例应用[J/CD].中华腔镜外科杂志(电子版),2018,11(4):247- 247.
12 关旭,王贵玉,周主青,等.79家医院718例结直肠肿瘤经自然腔道取标本手术回顾性研究[J/CD].中华结直肠疾病电子杂志,2017,6(6):469- 477.
13 Saurabh B,Chang SC,Ke TW,et al.Natural orifice specimen extraction with single stapling colorectal anastomosis for laparoscopic anterior resection:feasibility,outcomes,and technical considerations[J].Diseases of the Colon & Rectum,2017,60(1):43- 45.
14 Ersin G,Aydin A,Cuneyt K,et al.Two cases of laparoscopic total colectomy with natural orifice specimen extraction and review of the literature[J].Videosurgery and Other Miniinvasive Techniques,2017,12(3):291- 296.
15 Jr MEF,Russek K.Natural orifice specimen extraction in laparoscopic colorectal surgery:transanal and transvaginal approaches[J].Techniques in Coloproctology,2013,17(1):63- 67.
16 Denost Q,Adam JP,Pontallier A,et al.Laparoscopic total mesorectal excision with coloanal anastomosis for rectal cancer[J].Annals of Surgery,2015,261(1):138- 143.
17 Wolthuis AM,Fieuws S,Van DBA,et al.Randomized clinical trial of laparoscopic colectomy with or without natural- orifice specimen extraction[J].British Journal of Surgery,2015,102(6):630- 637.
18 Cai JC,Hong XY.Laparoscopic- assisted natural orifice specimen extraction radical descending colectomy using a cai tube[J].World Journal of Surgery,2016,40(11):2803- 2807.