切换至 "中华医学电子期刊资源库"
高级检索
中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2018, Vol. 07 ›› Issue (04) : 342 -346. doi: 10.3877/cma.j.issn.2095-3224.2018.04.007

所属专题： 经自然腔道取标本手术学； 文献；

论著

NOSES结直肠癌根治术后腹腔冲洗液肿瘤细胞学检测及细菌培养结果分析
彭健1,†(), 丁成明2, 贾泽民1, 陈杰1, 赵丹1, 张洋1, 杨智1, 邱俊3, 骆冬仁1, 何胖祥1, 钟树武1   
  1. 1. 410008　长沙，中南大学湘雅医院普外科
    2. 410008　长沙，中南大学湘雅医院普外科；421001　衡阳，南华大学第一附属医院普外科
    3. 421001　衡阳，南华大学第一附属医院普外科
  • 收稿日期:2018-04-19 出版日期:2018-08-25
  • 通信作者: 彭健
  • 基金资助:
    湘雅医院-北大未名临床与康复研究基金项目(No.20160201CF); 湖南省自然科学基金项目(No.2017JJ2334); 湖南省自然科学基金项目(No.2018JJ3471); 湖南省卫生计生委2018年度科研计划课题项目(No.C20180156)

Analysis of peritoneal lavage cytology and microbiology in patients with total laparoscopic resection for colorectal cancer by NOSES

Jian Peng1,†(), Chengming Ding2, Zemin Jia1, Jie Chen1, Dan Zhao1, Yang Zhang1, Zhi Yang1, Jun Qiu3, Dongren Luo1, Panxiang He1, Shuwu Zhong1   

  1. 1. Departmemt of General Surgery of Xiangya Hospital, Central South University, Changsha 410008, China
    2. Departmemt of General Surgery of Xiangya Hospital, Central South University, Changsha 410008, China; Departmemt of General Surgery of the First Affiliate Hospital, University of South China, Hengyang 421001, China
    3. Departmemt of General Surgery of the First Affiliate Hospital, University of South China, Hengyang 421001, China
  • Received:2018-04-19 Published:2018-08-25
  • Corresponding author: Jian Peng
  • About author:
    Corresponding author: Peng Jian, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

彭健, 丁成明, 贾泽民, 陈杰, 赵丹, 张洋, 杨智, 邱俊, 骆冬仁, 何胖祥, 钟树武. NOSES结直肠癌根治术后腹腔冲洗液肿瘤细胞学检测及细菌培养结果分析[J]. 中华结直肠疾病电子杂志, 2018, 07(04): 342-346.

Jian Peng, Chengming Ding, Zemin Jia, Jie Chen, Dan Zhao, Yang Zhang, Zhi Yang, Jun Qiu, Dongren Luo, Panxiang He, Shuwu Zhong. Analysis of peritoneal lavage cytology and microbiology in patients with total laparoscopic resection for colorectal cancer by NOSES[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2018, 07(04): 342-346.

目的

分析经自然腔道取标本手术（NOSES）完全腹腔镜下结直肠癌根治术后患者腹腔冲洗液的肿瘤细胞学检测、细菌培养的结果及其临床意义。

方法

留取2016年1月至2018年4月湘雅医院普外结直肠肛门外科30例行NOSES完全腹腔镜下结直肠癌根治术患者术后腹腔冲洗液，分装两份，分别送病理科查找肿瘤细胞和检验科行细菌培养，收集肿瘤细胞学检测及细菌培养结果，并与国内外文献报道的开腹和常规腹腔镜结直肠癌根治术腹腔冲洗液的肿瘤细胞检测及细菌培养结果比较分析。

结果

30例NOSES完全腹腔镜下结直肠癌根治术患者的腹腔冲洗液肿瘤细胞阳性的患者0例，阳性率0%（0/30）；细菌培养阳性的患者有10例，阳性率33.3%（10/30）；至目前为止30例NOSES患者术后均未出现盆/腹腔感染及盆/腹腔肿瘤的复发转移。这一结果与国内外文献报道的开腹及常规腹腔镜结直肠癌根治术后腹腔冲洗液的肿瘤细胞学检查（0%~45.5%）和细菌培养结果（20%~32.5%）相近。

结论

与开腹和常规腹腔镜结直肠癌根治术相比，NOSES结直肠癌根治术未增加患者术后盆腹腔感染及未促进肿瘤细胞种植转移，符合恶性肿瘤根治术的无菌无瘤原则，值得临床推广应用。

关键词: 结直肠肿瘤, 经自然腔道取标本手术, 细胞学检查, 微生物学检查, 无菌无瘤技术
Objective

To analyse the results of peritoneal lavage cytology and microbiology in patients with total laparoscopic resection for colorectal cancer by NOSES.

Methods

Examination of cytology and microbiology of peritoneal lavage were performed for thirty colorectal cancer patients who underwent total laparoscopic resection by NOSES from January 2016 to April 2018, then compared with the other studies reported about peritoneal lavage for cytology and microbiology of open and laparoscopic radical resection for colorectal cancer at home and abroad.

Results

Thirty colorectal cancer patients who underwent total laparoscopic resection by NOSES were performed the examination of peritoneal lavage for cytology and microbiology. There was no patients with positive cytology result (positive rate 0%), ten patients were with positive microbiology result (positive rate 33.3%) , no patients were with abdominopelvic cavity infection and tumor recurrence in abdominopelvic cavity. Our results were similar to the other studies reported about peritoneal lavage for cytology (0%~45.5%) and microbiology (20%~32.5%) of open and laparoscopic radical resection for colorectal cancer at home and abroad.

Conclusion

Total laparoscopic resection for colorectal cancer by NOSES didn't increase the rate of intraperitoneal implantation of colorectal cancer cells and intra-abdominal infections. It is worthy of clinical application and promotion conforming to the principle of aseptic and non tumor.

Key words: Colorectal neoplasms, Natural orifice specimen extraction surgery (NOSES), Cytology, Microbiology, Aseptic and tumor-free technique
图1 病理诊断：（腹水细胞学涂片、液基细胞学）见间皮细胞及淋巴细胞，未见癌细胞
[1]
Palanivelu C, Rangarajan M, Jategaonkar PA, et al. An Innovative Technique for Colorectal Specimen Retrieval: A New Era of ″Natural Orifice Specimen Extraction″ (N.O.S.E) [J]. Diseases of the Colon & Rectum, 2008, 51(7): 1120-1124.
[2]
于刚, 汪泳, 汪正广, 等. 86例腹腔引流液细菌培养及药敏结果分析 [J]. 安徽医学, 2017, 38(4): 425-427.
[3]
Fleshman JW, Nelson H, Peters WR, et al. Early results of Laparoscopic surgery for colorectal cancer: Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) study Group [J]. Dis Colon Rectum, 1996, 39(10 Suppl): S53-S58.
[4]
王耀辉, 陈钰, 高军, 等. 腹腔镜与开腹结直肠癌根治术后感染并发症的比较 [J]. 中国微创外科杂志, 2015(11): 979-981.
[5]
Bretagnol F, Lelong B, Laurent C, et al. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma [J]. Surg Endosc, 2005, 19(7): 892-896.
[6]
Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlledtrial [J]. Lancet, 2005, 365(9472): 1718-1726.
[7]
Kitano S, Inomata M, Sato A, et al. Randomized controlled trial to evaluate laparoscopic surgery for colorectal cancer Japan Clinical Oncology Group Study JCOG [J]. Jpn J Clioncol, 2005, 35(8): 475-477.
[8]
Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trail of laparoscopic-assisted resection of colorectal carcinoma: 3-years results of the UK MRC CLASICC Trial Group [J]. J Clin Oncol, 2007, 25(21): 3061-3068.
[9]
Rattner D, Kalloo A. ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery [J]. Gastrointestinal Endoscopy, 2006, 63(2): 199-203.
[10]
Franklin ME Jr, Ramos R, Rosenthal D, et al. Laparoscopic colonic procedures [J]. World J Surg, 1993, 17(1): 51-56.
[11]
Darzi A, Super P, Guillou PJ, et al. Laparoscopic sigmoidcolectomy: total laparoscopic approach [J]. Dis Colon Rectum, 1994, 37(3): 268-271.
[12]
Franklin ME, Kazantsev GB, Abrego D, et al. Laparoscopic surgery for stageⅢcolon cancer: long-term follow-up [J]. Surg Endosc, 2000, 14(7): 612-616.
[13]
Laurent C, Leblanc F, Gineste C, et al. Laparoscopic approach in surgical treatment of rectal cancer [J]. Br J Surg, 2007, 94(12): 1555-1561.
[14]
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.
[15]
王锡山.中国NOSES面临的挑战与展望 [J/CD]. 中华结直肠疾病电子杂志, 2018(1): 2-7.
[16]
中国NOSES联盟. 结直肠肿瘤经自然腔道取标本手术专家共识(2017) [J]. 临床医学研究与实践, 2017, 6(25): 266-272.
[17]
魏雪，潘莹，刘庆，等. 结直肠手术不同手术方式术后引流液分离阳性率与SSIs相关性分析 [J]. 2014, 年广东省药师周大会论文集, 103-109.
[18]
Ngu J, Wong AS. Transanal natural orifice specimen extraction in colorectal surgery: bacteriological and oncological concerns [J]. Anz Journal of Surgery, 2016, 86(4): 299-302.
[19]
胡三元, 杨庆芸, 张光永, 等. 经胃及阴道内镜胆囊切除动物实验研究 [J]. 腹腔镜外科杂志, 2008, 13(6): 479-483.
[20]
Altomare DF, Tedeschi M, Rotelli MT, et al. Lack of prognostic role of pre-and postoperative peritoneal cytology and cytokeratin PCR-expression on local recurrence after curative anterior resection for mid-low rectal cancer [J]. Updates in Surgery, 2011, 63(2): 109-113.
[21]
Lloyd JM, Mciver CM, Stephenson SA, et al. Identification of early-stage colorectal cancer patients at risk of relapse post-resection by immunobead reverse transcription-PCR analysis of peritoneal lavage fluid for malignant cells. [J]. Clinical Cancer Research, 2006, 12(2): 417-423.
[22]
Nikai H, Koyama M, Morohashi H, et al. Retrospective Study of the Usefulness of Peritoneal Lavage Cytology in Patients with Curative Resection for Colorectal Cancer [J]. Journal of the Japanese Practical Surgeon Society, 2015, 76(3): 466-471.
[23]
许万松, 于洪亮, 杨茂鹏, 等. 大肠癌患者术中腹腔冲洗液中SurvivinmRNA的检测及临床意义 [J]. 临床外科杂志, 2007, 15 (5): 333-335.
[24]
陈荣, 蔡景理, 刘长宝, 等. 结直肠癌患者手术前后腹腔脱落肿瘤细胞检测的临床意义 [J]. 中华胃肠外科杂志, 2005, 8(2): 174-175.
[1] 康夏, 田浩, 钱进, 高源, 缪洪明, 齐晓伟. 骨织素抑制破骨细胞分化改善肿瘤骨转移中骨溶解的机制研究[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 329-339.
[2] 代莉, 邓恢伟, 郭华静, 黄芙蓉. 术中持续输注艾司氯胺酮对腹腔镜结直肠癌手术患者术后睡眠质量的影响[J]. 中华普通外科学文献(电子版), 2023, 17(06): 408-412.
[3] 王得晨, 杨康, 杨自杰, 归明彬, 屈莲平, 张小凤, 高峰. 结直肠癌微卫星稳定状态和程序性死亡、吲哚胺2,3-双加氧酶关系的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(06): 462-465.
[4] 付佳, 肖海敏, 武曦, 冯涛, 师帅. 年龄校正查尔森合并症指数对腹腔镜结直肠癌围手术期并发症的预测价值[J]. 中华普通外科学文献(电子版), 2023, 17(05): 336-341.
[5] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[6] 张生军, 赵阿静, 李守博, 郝祥宏, 刘敏丽. 高糖通过HGF/c-met通路促进结直肠癌侵袭和迁移的实验研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 21-24.
[7] 李婷, 张琳. 血清脂肪酸代谢物及维生素D水平与结直肠癌发生的关系研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 661-665.
[8] 常剑, 邱峰, 毛郁琪. 摄食抑制因子-1与腹腔镜结直肠癌根治术后肝转移的关系分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 502-505.
[9] 王晓燕, 肖佑, 肖戈, 王真权. 老年结直肠癌肺转移CT特征及高危因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 506-509.
[10] 李博, 胡刚, 邱文龙, 汤坚强, 王锡山. 多功能吲哚菁绿近红外荧光血管成像技术在腹腔镜直肠癌经自然腔道取标本手术（NOSES Ⅳ式）中的应用（附视频）[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 524-528.
[11] 倪文凯, 齐翀, 许小丹, 周燮程, 殷庆章, 蔡元坤. 结直肠癌患者术后发生延迟性肠麻痹的影响因素分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 484-489.
[12] 范小彧, 孙司正, 鄂一民, 喻春钊. 梗阻性左半结肠癌不同手术治疗方案的选择应用[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 500-504.
[13] 关旭, 王锡山. 基于外科与免疫视角思考结直肠癌区域淋巴结处理的功与过[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 448-452.
[14] 顾睿祈, 方洪生, 蔡国响. 循环肿瘤DNA检测在结直肠癌诊治中的应用与进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 453-459.
[15] 张继新, 胡军红, 谢爽, 武祖印, 张春旭. 经阴道单孔腹腔镜阑尾切除术可行性及近期疗效分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 460-465.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号