腹腔镜结直肠癌根治术临床应用与观察

目的:探究结直肠癌患者采用腹腔镜下经自然腔道取出标本的结直肠癌根治术治疗疗效以及临床应用价值。方法:选择2016年5月至2019年5月期间在我院进行治疗的55例结直肠癌患者作为研究对象,按照随机数字表分组法以近似1:1原则分成2组,腹部无辅助切口经直肠拉出标本腹腔镜下直肠癌根治术(natural orifice tmnsluminal endoscopic surgery,NOSES)组(n=27)与常规组(n=28),分别应用NOSES与常规腹腔镜进行结直肠癌根治术治疗。记录并比较术中出血量、手术时间、淋巴结清扫数目、平均远切端距离、胃肠道功能恢复时间、术后疼痛评分、下床活动时间及住院时间等围手术期相关指标,感染、吻合口漏、炎性肠梗阻、死亡等术后并发症发生率。采用Saito分级标准与五项十分制表评估术后4周排尿以及排便情况,通过随访评估患者术后1年生存情况。结果:两组患者手术时间、淋巴结清扫数目、平均远切端距离差异不显著(P>0.05),术中出血量、胃肠道功能恢复时间、术后疼痛评分、下床活动时间以及住院时间均少于常规组(P<0.05);NOSES组与常规组患者并发症发生率分别为11.11%和32.14%,两组并发症发生率无统计学差异(P>0.05);NOSES组与常规组患者术后4周排尿与排便情况无统计学差异(P>0.05);NOSES组患者术后1年远处转移率、局部复发率低于常规组,生存率高于常规组,但无统计学差异(P>0.05)。结论:虽然NOSES手术远期疗效、安全性与常规腹腔镜手术相当,但其近期疗效优于常规腹腔镜手术。

Clinical application and observation of laparoscopic radical resection for colorectal cancer

Objective:To explore the curative effect and clinical application value of laparoscopic radical resection for colorectal cancer inpatients.Methods:A total of 55 patients with colorectal cancer treated in our hospital from May 2016 to May 2019 were selected.All patients were divided into 2 groups by random number table methods.The patients in natural orifice transluminal endoscopic surgery(NOSES)group(n=27)were treated with NOSES,while patients in the conventional group(n=28)were treated with conventional laparoscopic radical resection of colorectal cancer.Intraoperative blood loss,operation time,number of lymph node removed,average distanceto the distal end,gastrointestinal function recovery time,postoperative pain score,leaving bed time and length of hospital stay,incidences of infection,anastomotic leakage,inflammatory intestinal obstruction and death were comparatively analyzed.The urination and defecation at 4 weeks after operation were evaluated by Saito grading standard and five tenth table,and the survival at 1 year after operation was evaluated by follow-up.Results:There was no significant difference in surgical time,number of lymph nodes removed or mean distal end distance between the two groups(P>0.05).The intraoperative blood loss,recovery time of gastrointestinal function,postoperative pain scores,time to get out of bed and length of hospital stay in NOSES group were less/shorter than those in the conventional group(P<0.05).There was no significant difference in the incidence of complications between the two groups(11.11%vs 32.14%,P>0.05).There was no significant difference in urination or defecation between the two groups at 4 weeks after surgery(P>0.05).The distant metastasis rate and local recurrence rate in NOSES group were lower than those in the conventional group,while survival rate was higher than that in the conventional group in 1 year after surgery(P>0.05).Conclusion:Although the long-term efficacy and safety of noses are similar to that of conventional laparoscopic surgery,the short-term efficacy of noses is better than that of conventional laparoscopic surgery.