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中华结直肠疾病电子杂志 ›› 2022, Vol. 11 ›› Issue (01) : 36 -43. doi: 10.3877/cma.j.issn.2095-3224.2022.01.006

论著

经自然腔道取标本手术与常规腹腔镜手术在左半结肠癌治疗中的疗效对比
管子龙1, 王玉柳明1, 胡汉卿1, 张浩1, 李正梁1, 徐超1, 罗康佳1, 欧苏文1, 郁雷1, 汤庆超1, 黄睿1,(), 王贵玉1,()   
  1. 1. 150081 哈尔滨医科大学附属第二医院结直肠肿瘤外科
  • 收稿日期:2020-11-01 出版日期:2022-02-25
  • 通信作者: 黄睿, 王贵玉
  • 基金资助:
    国家科学自然基金(81872034); 黑龙江科学基金(H2017016); 陈孝平科技发展基金(CXPJJH12000002-2020025); 吴阶平医学基金(320.6750.19092-41)

Efficacy comparison of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery for left colon cancer

Zilong Guan1, Yuliuming Wang1, Hanqing Hu1, Hao Zhang1, Zhengliang Li1, Chao Xu1, Kangjia Luo1, Suwen Ou1, Lei Yu1, Qingchao Tang1, Rui Huang1,(), Guiyu Wang1,()   

  1. 1. Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
  • Received:2020-11-01 Published:2022-02-25
  • Corresponding author: Rui Huang, Guiyu Wang
引用本文:

管子龙, 王玉柳明, 胡汉卿, 张浩, 李正梁, 徐超, 罗康佳, 欧苏文, 郁雷, 汤庆超, 黄睿, 王贵玉. 经自然腔道取标本手术与常规腹腔镜手术在左半结肠癌治疗中的疗效对比[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(01): 36-43.

Zilong Guan, Yuliuming Wang, Hanqing Hu, Hao Zhang, Zhengliang Li, Chao Xu, Kangjia Luo, Suwen Ou, Lei Yu, Qingchao Tang, Rui Huang, Guiyu Wang. Efficacy comparison of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery for left colon cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(01): 36-43.

目的

对比经自然腔道取标本手术(NOSES)与常规腹腔镜手术在左半结肠癌根治术中的疗效及预后情况,论证NOSES手术的安全性及可行性。

方法

收集2013年5月至2017年5月就诊于哈尔滨医科大学附属第二医院结直肠肿瘤外科并进行手术治疗的127例左半结肠癌患者的临床资料,包括患者一般基础资料、手术相关资料、术后短期预后资料以及长期随访资料。利用患者的基础信息进行1∶1倾向性得分匹配,进行回顾性分析。

结果

采用倾向性得分匹配法,两组均纳入48例患者。统计结果显示,NOSES组患者的短期预后明显优于常规腹腔镜组,包括术后排气时间(Z=-2.539,P=0.011),术后进食时间(Z=-4.117,P<0.001),术后住院天数(Z=-5.846,P<0.001),术后1日(Z=9.565,P<0.001)、3日(Z=12.885,P<0.001)、5日(Z=7.053,P<0.001)、7日(Z=2.537,P=0.014)疼痛评分等差异均具有统计学意义;在长期预后患者EORTCQLQ-C30量表评分方面,NOSES患者在总体健康状况(Z=-4.808,P<0.001)、角色功能(Z=-2.476,P=0.013)、情绪功能(Z=-3.075,P=0.002)、认知功能(Z=-2.423,P=0.015)及社会功能(Z=-3.639,P<0.001)等方面均有明显优势。而在肛门功能Parks评分,术后并发症以及生存分析等方面,两组差异均无统计学意义。

结论

NOSES手术的安全性不劣于常规腹腔镜手术,并且在术后恢复的某些方面上优于常规腹腔镜手术。因此,NOSES手术是安全的,是可行的。

Objective

To demonstrate the safety and feasibility of natural orifice specimen extraction surgery (NOSES) by comparing the efficacy and prognosis between NOSES and conventional laparoscopic surgery for left colon cancer patients.

Methods

127 left colon cancer patients who underwent surgery in the Second Affiliated Hospital of Harbin Medical University from May 2013 to May 2017 were enrolled. Collecting clinical data, includes demographic data, surgical data, short-term and long-term follow-up data. The general data of the patients was matched by the propensity score matching method 1∶1. The data was retrospectively analyzed.

Results

After propensity score matching forty-eight patients underwent NOSES and 48 patients underwent laparoscopic surgery. Compared with laparoscopic surgery, NOSES resulted in significantly better short-term prognosis in postoperative exhaust time (Z=-2.539, P=0.011), postoperative feeding time (Z=-4.117, P<0.001), postoperative hospital stay days (Z=-5.846, P<0.001), postoperative pain score of the first day (Z=9.565, P<0.001), third day (Z=12.885, P<0.001), fifth day (Z=7.053, P<0.001) and seventh day (Z=2.537, P=0.014). European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTCQLQ-C30) was applied to evaluate long-term prognosis of two groups, indicating the NOSES group was significantly better in general health condition (Z=-4.808, P<0.001), role function (Z=-2.476, P=0.013), emotional function (Z=-3.075, P=0.002), cognitive function (Z=-2.423, P=0.015), and social function (Z=-3.639, P<0.001). However, there was no statistically significant difference with regards to anal functional Parks score, postoperative complications, and survival analysis (all P>0.05).

Conclusions

The safety of NOSES operation is no less than that of laparoscopic surgery. Moreover, NOSES operation is superior to conventional laparoscopic surgery in some aspects of postoperative recovery. Therefore, the NOSES operation is safe and feasible.

图1 NOSES手术过程。1A:经戳卡置入保护套,打开直肠残端;1B:吻合器抵钉座经保护套置入腹腔;1C:打开肿瘤上方肠管并用碘伏纱条消毒;1D:将吻合器钉座送入上方肠管;1E:将标本经肛门拉出体外;1F:直肠断端闭合后标本装入取物袋;1G:进行吻合器对接;1H:加固缝合吻合口;1I:注气注水试验检查吻合口
表1 倾向性得分匹配前入组患者基本资料[例(%)]
表2 倾向性得分匹配后入组患者基本资料[例(%)]
表3 两组患者手术情况及术后恢复情况[
xˉ
±s,例(%)]
图2 两组患者术后1、3、5、7天VAS疼痛评分
表4 两组患者Parks肛门功能等级评定
图3 两组患者的Kaplan-Meier生存曲线
表5 两组患者EORTCQLQ-C30术后生活质量评分
图4 两组患者术后生活质量评分对比
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