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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (04) : 282 -287. doi: 10.3877/cma.j.issn.2095-3224.2023.04.003

达芬奇机器人专栏

机器人辅助直肠癌NOSES术后细菌学及肿瘤学结果的前瞻性研究
朱伟权, 叶善平, 唐和春, 刘东宁, 鞠后琼, 仲崇晗, 黄智翔, 李太原†()   
  1. 341000　赣州市人民医院胃肠外科
    330006　南昌大学第一附属医院普外科
  • 收稿日期:2022-10-29 出版日期:2023-08-25
  • 通信作者: 李太原
  • 基金资助:
    江西省重点研究项目(20202BBG73032)

A prospective study of recent bacteriological and oncological significance after NOSES for robotic rectal cancer

Weiquan Zhu, Shanping Ye, Hechun Tang, Dongning Liu, Houqiong Ju, Chonghan Zhong, Zhixiang Huang, Taiyuan Li†()   

  1. Department of Gastrointestinal Surgery, Ganzhou People's Hospital, Ganzhou 341000, China
    Department of Gastrointestinal Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, China
  • Received:2022-10-29 Published:2023-08-25
  • Corresponding author: Taiyuan Li
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朱伟权, 叶善平, 唐和春, 刘东宁, 鞠后琼, 仲崇晗, 黄智翔, 李太原. 机器人辅助直肠癌NOSES术后细菌学及肿瘤学结果的前瞻性研究[J]. 中华结直肠疾病电子杂志, 2023, 12(04): 282-287.

Weiquan Zhu, Shanping Ye, Hechun Tang, Dongning Liu, Houqiong Ju, Chonghan Zhong, Zhixiang Huang, Taiyuan Li. A prospective study of recent bacteriological and oncological significance after NOSES for robotic rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(04): 282-287.

目的

探讨机器人辅助经自然腔道取标本直肠癌根治术（R-NOSES）无菌、无瘤效果，并分析其术后短期临床疗效。

方法

前瞻性纳入2020年5月~2021年3月于南昌大学第一附属医院普外科就诊的66例直肠癌患者的临床资料，经过排除及退出标准后，共有63例患者成功入组，其中32例行机器人辅助直肠癌根治术（R-S），31例行R-NOSES手术。通过对两组患者的围手术期临床病理资料、细菌学和肿瘤学结果进行比较，分析机器人辅助经自然腔道取标本直肠癌根治术后的无菌无瘤效果及短期临床疗效。

结果

在术后细菌学方面，R-NOSES组与R-S组的腹腔冲洗液细菌培养阳性率差异无统计学意义（12.90% vs. 6.25%，χ2=0.131，P＞0.05），两组患者术后腹腔冲洗液肿瘤学检测均为阴性。与R-S组相比，R-NOSES组的术中出血量更少（43.67±20.08 vs.62.36±29.01，t=-4.237，P＜0.05），术后第一天VAS疼痛评分更低（3.83±0.75 vs. 4.97±0.73，t=-7.342，P＜0.001）；术后第三天VAS疼痛评分更低（1.90±0.85 vs. 2.93±0.96，t=-5.352，P＜0.001）。而在手术时间、术后排气时间、术后首次进流质时间、术后拔除尿管时间、术后拔除引流管时间、术后住院时间及术后并发症发生率上，两组差异无统计学意义（P＞0.05）。

结论

R-NOSES组与R-S组肿瘤学及细菌学结果相似，且R-NOSES手术术中出血更少，疼痛更轻，微创优势更为明显。

关键词: 直肠肿瘤, 经自然腔道取标本手术, 达芬奇机器人手术系统, 细菌学, 肿瘤学
Objective

To investigate the aseptic and tumor free effect of robot assisted radical resection of rectal cancer by natural origin specific extraction surgery (R-NOSES), and analyze its short-term clinical efficacy.

Methods

The clinical data of 66 patients with rectal cancer who visited the General Surgery Department of the First Affiliated Hospital of Nanchang University from May 2020 to March 2021 were prospectively included. After exclusion and withdrawal criteria, sixty-three patients were successfully enrolled, including 32 patients with robot assisted radical resection of rectal cancer (R-S) and 31 patients with R-NOSES. By comparing the perioperative clinicopathological data, bacteriological and oncological results of the two groups of patients, the aseptic and tumor free effect and short-term clinical efficacy of robot assisted radical resection of rectal cancer through natural cavity were analyzed.

Results

In terms of postoperative bacteriology, there was no significant difference in the positive rate of bacterial culture of peritoneal washings between the R-NOSES group and the R-S group (12.90% vs.6.25%, χ2=0.131, P＞0.05), and the oncological detection of peritoneal washings in both groups was negative. Compared with R-S group, R-NOSES group had less intraoperative bleeding (43.67±20.08 vs.62.36±29.01, t=-4.237, P＜0.05) and lower VAS pain score on the first day after operation (3.83±0.75 vs.4.97±0.73, t=-7.342, P＜0.001). The VAS pain score was lower on the third day after operation (1.90±0.85 vs.2.93±0.96, t=-5.352, P＜0.001). There was no significant difference between the two groups in terms of operation time, postoperative exhaust time, postoperative first fluid intake time, postoperative catheter removal time, postoperative drainage tube removal time, postoperative hospital stay and postoperative complication rate (P＞0.05).

Conclusion

The results of oncology and bacteriology in R-NOSES group are similar to those in R-S group, and R-NOSES operation has less intraoperative bleeding, less pain, and more obvious minimally invasive advantages.

Key words: Rectal neoplasms, Natural orifice specimen extraction surgery, Da Vinci robotic surgery system, Bacteriology, Oncology
表1 患者术前一般临床资料对比（
x¯
±s，例）
组别 例数 性别

年龄

（岁）

 BMI ASA 术前CEA CA19-9 术前T分期
男 女 Ⅰ Ⅱ Ⅲ 升高 正常 升高 正常 T1 T2 T3
R-NOSES组 31 19 12 57.48±8.56 22.16±2.52 11 16 4 27 4 28 3 10 17 4
R-S组 32 23 9 61.34±10.72 22.79±2.39 9 18 5 26 6 28 4 7 19 6
t/χ2值 0.794 -1.576 -1.006 0.413 0.403 0.127 0.132
P值 0.373 0.12 0.318 0.813 0.525 0.822 0.599
表2 患者围术期临床资料对比（
x¯
±s）
组别 手术出血量（mL） 手术时间（min） 术后排气时间（h） 首次进流质时间（h） 术后住院时间（d） 术后拔除尿管时间（d） 术后拔除引流管时间（d） 术后VAS评分
1 3 5
R-NOSES组 43.67±20.08 153.87±19.61 38.67±8.52 55.53±11.36 8.3±3.13 4.60±0.72 7.43±2.87 3.83±0.75 1.90±0.85 1.70±0.70
R-S组 62.36±29.01 154.69±16.16 42.55±8.47 59.03±11.97 8.93±4.51 4.52±0.79 8±4 4.97±0.73 2.93±0.96 1.69±0.66
t/χ2值 -4.237 1.402 -1.075 -0.905 -2.342 -3.342 -1.312 -7.342 -5.352 2.521
P值 ＜0.05 0.857 0.053 0.382 0.112 0.693 0.068 <0.001 <0.001 0.685
表3 患者术后病理资料对比（
x¯
±s，例）
组别 肿瘤大小（cm） 清扫淋巴结数目（枚） 阳性淋巴结数目（枚） TNM分期 脉管侵犯 神经侵犯
Ⅰ Ⅱ Ⅲ 阳性 阴性 阳性 阴性
R-NOSES组 2.99±0.95 10.26±4.55 3.30±1.66 8 10 13 3 28 1 30
R-S组 3.30±1.66 12.06±4.09 0.34±0.87 9 8 15 4 28 2 30
t/χ2值 -1.752 0.215 0.842 0.409 0.127 0.31
P值 0.583 0.103 0.331 0.815 0.822 0.573
表4 两组患者细菌培养结果（例）
组别 细菌培养 总例数 阳性率（%）
阴性 阳性
R-NOSES组 27 4 31 12.90
R-S组 30 2 32 6.25
χ2值 0.131
P值 0.368
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