比较经自然腔道取标本（NOSES）机器人直肠癌根治术与常规机器人辅助直肠癌根治术的术后机体应激反应及免疫功能变化。

本研究前瞻性纳入2020年5月至2021年3月期间在南昌大学第一附属医院胃肠外科拟行机器人直肠癌根治术的66例直肠腺癌患者。所有入组患者按照随机数字法随机分为机器人NOSES组（33例）和常规机器人组（33例），分别接受NOSES机器人手术和常规机器人手术，2例机器人NOSES组患者术中发现不宜行NOSES手术被剔除，1例常规机器人组术后病理结果显示为直肠腺瘤，按病例退出标准被剔除；最后入组机器人NOSES组31例，常规机器人组32例。收集所有患者临床及辅助检查资料比较两组患者应激反应（白细胞、中性粒细胞、CRP、IL-6和IL-8）及免疫功能（CD3⁺T细胞百分比、CD4/CD8，Hb及ALB）变化。

两组患者基线资料比较，差异均无统计学意义（均P＞0.05）。两组患者术前一天白细胞、中性粒细胞、CRP、IL-6和IL-8水平差异均无统计学意义（t=-0.654、-1.046、-0.390，U=458.0、480.0；P均＞0.05），手术后第一天和第三天白细胞、中性粒细胞、CRP、IL-6和IL-8水平均高于术前一天，且机器人NOSES组术后第一天白细胞、中性粒细胞、CRP、IL-6及IL-8均低于常规机器人手术组，差异有统计学意义（t=-2.124、-3.758、-2.325，U=318.0、343.0；P均＜0.05）；术后第三天机器人NOSES组CRP、IL-6及IL-8水平低于常规机器人组，差异有统计学意义（t=-2.159，U=340.0、338.0；P均＜0.05）；术后第七天，两组间白细胞、中性粒细胞、IL-6及IL-8水平差异无统计学意义（t=-0.556、-1.058，U=403.5、446.5，P均＞0.05），机器人NOSES组CRP水平低于常规机器人组，差异有统计学意义（t=-2.778，P＜0.05）。机器人NOSES组术前一天CD3⁺T细胞百分比及CD4/CD8与常规机器人组差异无统计学意义（t=-0.599、-0.497，P＞0.05）；两组患者术后第一天、第三天、第七天CD3⁺T细胞百分比及CD4/CD8均低于术前一天，且机器人NOSES组术后第一天、第三天及第七天CD3⁺T细胞百分比及CD4/CD8均高于常规机器人手术组，差异有统计学意义（t=2.514、2.158，t=4.154、2.289，t=6.790、2.587；P＜0.05）。两组患者术后第一天、第三天血清白蛋白及血红蛋白均低于术前一天；其中术前一天及术后第一天机器人NOSES组血清白蛋白及血红蛋白水平与常规机器人组差异无统计学意义（t=-0.756、-0.629，t=0.620、-0.441；P＞0.05）。术后第三天及术后第七天机器人NOSES组血清白蛋白及血红蛋白高于常规机器人组，差异有统计学意义（t=3.712、2.125，t=2.913、2.090，P＜0.05）。

NOSES机器人直肠癌根治术创伤更小，机体应激反应更轻，且恢复更快，加速患者康复。

To compare the changes of stress response and immune function between natural orifice specimen extraction (NOSES) during robotic rectal radical resection and conventional robot-assisted radical resection.

This study prospectively enrolled 66 patients with rectal adenocarcinoma who were to undergo robotic radical resection of rectal cancer in the department of gastrointestinal surgery, the First Affiliated Hospital of Nanchang University from May 2020 to March 2021. According to the random number method, all patients were randomly divided into the robotic NOSES group (33 cases) and the routine robotic surgery group (33 cases), respectively, to receive robotic specimen removal through the natural cavity and routine robotic surgery. Two cases of patients in the robot NOSES group who were found to be unsuitable for NOSES surgery during the operation were excluded, and 1 case in the conventional robot surgery group was found to be a rectal adenoma after postoperative pathology, and was excluded according to the case withdrawal criteria. Clinical and auxiliary examination data of all patients were collected to compare the changes of stress response and immune function of patients in the two groups.

There was no significant difference in baseline data between the two groups (all P＞0.05). There were no significant differences in the levels of white blood cells, neutrophils, CRP, IL-6 and IL-8 in 2 groups on the day before surgery (t=-0.654, -1.046, -0.390, U=458.0, 480.0; P＞0.05), but the levels of white blood cells, neutrophils, CRP, IL-6 and IL-8 on the first and third day after surgery were all higher than those on the day before surgery.The white blood cells, neutrophils, CRP, IL-6 and IL-8 in the NOSES group were lower than those in the conventional robotic surgery group on the first day after the operation, and the difference was statistically significant (t=-2.124, -3.758, -2.325, U=318.0, 343.0; P＜0.05).The levels of white blood cells, CRP, IL-6 and IL-8 in the Nose group on the third day after the operation were lower than those in the conventional robot group, the difference was statistically significant (t=-2.159, U=340.0, 338.0; P＜0.05). On the seventh day after the operation, there were no statistically significant differences in the levels of white blood cells, neutrophils, IL-6 and IL-8 between the two groups (t=-0.556, -1.058, U=403.5, 446.5; P＞0.05), and the CRP level in the Nose group was lower than that in the conventional robot group (t=-2.778, P＜0.05).The percentage of CD3⁺T cells and CD4/CD8 in the NOSES group one day before surgery were not significantly different from those in the conventional robot group (t=-0.599, -0.497; P＞0.05). The percentages of CD3⁺T cells and CD4/CD8 in the two groups on the first, third and seventh days after the operation were lower than those in the one day before the operation. The percentages of CD3⁺T cells and CD4/CD8 in the Nosing group were higher than those in the conventional robotic surgery group on the first, third and seventh days after the operation.The difference was statistically significant (t=2.514, 2.158, t=4.154, 2.289, t=6.790, 2.587; P＜0.05). Serum albumin and hemoglobin on the first and third day after surgery in 2 groups were lower than the day before surgery. The albumin and hemoglobin levels in the 1 day before and 1 day after Nosing group were not significantly different from those in the conventional robot group (t=-0.756, -0.629, t=0.620, -0.441; P＞0.05). The albumin and hemoglobin in the 3rd and 7th postoperative NOSES were higher than those in the conventional robot group, and the difference was statistically significant (t=3.712, 2.125, t=2.913, 2.090; P＜0.05).

The natural orifice specimen extraction during robotic rectal radical resection may cause a higher short-term inflammatory response in patients after surgery, but does not prolong the inflammatory response time, and returns to normal faster than the conventional robot group. Natural orifice specimen extraction during robotic rectal radical resection has little influence on the immune system of patients, and the recovery is faster, which is conducive to reducing the possibility of postoperative infectious complications and promoting the recovery of patients.