两步翻出直肠法在低位直肠癌经自然腔道取标本手术中的应用(附39例报告)

doi:10.13481/j.1671-587x.20190336

摘要/Abstract

摘要： 目的：比较腹腔镜低位直肠癌根治经自然腔道取标本手术（NOSES）中两步翻出直肠法和传统一步翻出直肠法的围手术期及近期疗效。方法：回顾性分析63例行腹腔镜低位直肠癌NOSES患者的临床资料，其中39例患者采用两步翻出直肠法取出直肠标本（两步翻出直肠法组），24例患者采用传统一步翻出直肠法（传统一步翻出直肠法组），并结合文献复习观察两步翻出直肠法在低位直肠癌经自然腔道取标本手术中应用的可行性。结果：记录2组患者肿瘤最大直径、翻出成功率、肿瘤破碎率、手术时间、术中出血量、术后首次排气时间、吻合口漏发生率和短期随访结果。两步翻出直肠法组39例标本均从肛门顺利翻出，切除后完成吻合，顺利完成低位直肠癌NOSES，而传统一步翻出直肠法组24例中有3例翻出失败，2组翻出成功率比较差异有统计学意义（P=0.024）；翻出后两步翻出直肠法组患者肿瘤破碎率低于传统一步翻出直肠法组（P=0.004），两步翻出直肠法组患者手术时间少于传统一步翻出直肠法组（t=4.266，P<0.01）。2组患者肿瘤最大直径（t=-0.406，P=0.686）、术中出血量（t=-1.247，P=0.217）、术后首次排气时间（t=-0.144，P=0.886）和术后吻合口漏发生率（P=1.000）比较差异均无统计学意义。随访3~24个月，两步翻出直肠法组和传统一步翻出直肠法组患者直肠癌复发率（P=0.140）及肿瘤转移率（P=0.360）比较差异无统计学意义。结论：两步翻出直肠法在低位直肠癌NOSES中能降低直肠翻出难度，减少手术时间，获得良好的近期疗效。

关键词: 直肠肿瘤, 两步翻出直肠法, 经自然腔道取标本手术, 复发率, 转移率

Abstract: Objective:To compare the perioperative and recent curative effects of laparoscopic radical resection of low rectal rectal carcinoma by natural orifice specimen extraction surgery(NOSES) with two-step procedure to turn rectum out from the abdominal cavity and traditional one-step procedure to turn rectum out from abdominal cavity. Methods:The clinical data of 63 patients who were treated by laparoscopic radical resection of low rectal rectal carcinoma by NOSES were analyzed retrospectively. A total of 39 patients were treated with the method of two-step procedure to turn rectum out from the abdominal cavity (two-step procedure group)and 24 patients were treated with the traditional one-step procedure to turn rectum out from the abdominal cavity(traditional one-step procedure group). Results:The maximum tumor diameters, the successful rates, tumor fragmentation rates, operation time, intraperative bleeding loss, postoperative exhaust time, anastomotic leakage rates after operation,and the short-term-follow-up results of the patients in two groups were recovered. The specimens of 39 patients in two-step procedure group were successfully pulled out from the anus, the anastomosis was finishehed after resection, and the NOSES of low rectal carcinoma was successfully completed,while 3 cases were failed of 24 cases in traditional one-step procedure group, the successful rate was decreased(P=0.024).After the specimen were pulled out from the anus,the fragmentation rate of the patients in two-step procedure group was lower than that in traditional one-step procedure group (P=0.004). The operation time of the patients in two-step procedure group was less than that in traditional one-step procedure group (t=4.266,P<0.01).There were no significant differences in the maximum diameters of tumor(t=-0.406,P=0.686),intraoperative bleeding loss(t=1.799,P=0.075), postoperative exhaust time (t=-0.144,P=0.886), postoperative anastomotic leakage rate(P=1.000)of the patients between two groups. During 3 to 24 months of follow-up,there were no significant differences in the recurrence rate(P=0.140) and metastatic rate of carcinoma (P=0.36) of the patients between two groups. Conclusion:Two-step procedure to turn rectum out from the abdominal cavity can reduce the pressure on the tumor during turning the rectum out,which can save the operation time and get good short-term curative effect during the radical resection of low rectal carcinoma by NOSES.

Key words: rectal neoplasms, two-step procedure to turn rectum out, natural orifice specimen extraction surgery, recurrence rate, metastatic rate

中图分类号:

R735.37

段吉清, 所剑, 孙东辉. 两步翻出直肠法在低位直肠癌经自然腔道取标本手术中的应用(附39例报告)[J]. 吉林大学学报(医学版), 2019, 45(03): 683-687.

DUAN Jiqing, SUO Jian, SUN Donghui. Application of two-step procedure to turn rectum out from abdominal cavity in radical resection of low rectal carcinoma by natural orifice specimen extraction surgery: A report of 39 cases[J]. Journal of Jilin University(Medicine Edition), 2019, 45(03): 683-687.

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