ERAS理念下NOSES在左半结肠癌腹腔镜下根治术中的应用研究

目的探讨快速康复外科（ERAS）理念下经自然腔道取标本手术（NOSES）在左半结肠癌腹腔镜下根治术中的应用效果。 方法回顾性分析2019年1月至2020年12月80例左半结肠癌患者的临床资料，按术式不同将患者分为常规组和NOSES组，每组40例，两组均在ERAS理念指导下行腹腔镜左半结肠癌根治术，NOSES组采用NOSES法取出标本，常规组经辅助切口取标本。选用SPSS 22.0软件处理数据，围术期指标行独立t检验，NRS疼痛评分行重复测量方差分析，术后并发症情况行χ²检验，P<0.05 表示差异有统计学意义。 结果两组手术时间、术中出血量、淋巴结清扫个数及引流管拔除时间比较差异无统计学意义（P>0.05）；NOSES组患者术后首次下床、排气、排便时间及术后住院时间均显著缩短（P<0.05）。时间与方法在NRS疼痛评分上不存在交互作用（P>0.05），时间与方法在NRS疼痛评分上主效应显著，NOSES组患者术后疼痛程度轻于常规组（P<0.05）。NOSES组患者术后总并发症发生率显著比常规组低（5.0% vs. 20.0%），差异有统计学意义（P<0.05）。 结论ERAS与NOSES联合应用于左半结肠癌腹腔镜治疗中，两者优势互补，具有疼痛轻、并发症少及康复快等优势，值得临床推广应用。

Application of ERAS NOSES in laparoscopic radical resection of left semicolon colon cancer

ObjectiveTo investigate the application of NOSES under ERAS concept in laparoscopic radical resection of left colorectal cancer. MethodsThe clinical data of 80 patients with left colon cancer from January 2019 to December 2020 were retrospectively analyzed. The patients were divided into the conventional group and the Diluted group respectively，40 cases in each group. Both groups underwent laparoscopic radical resection of left colon cancer under the guidance of ERAS concept. In the conventional group，specimens were collected through auxiliary incision. SPSS 22.0 software was used to process the data. Independent t-test was used for perioperative indicators，repeated measurement an OVA was used for NRS pain score，and χ² test was performed for postoperative complications. P<0.05 indicated statistically significant differences. ResultsThere were no significant differences in operative time，intraoperative blood loss，number of lymph node dissection and drainage tube removal time between the two groups（P>0.05）. The first time out of bed，the time to exhaust，the time to defecate and the time to stay in hospital after the NOSES group were significantly reduced（P<0.05）. There is no interaction between time and method on THE NRS pain score（P>0.05）. The main effect of time and method on the NRS pain score is significant. The postoperative pain in the NOSES group is lighter than that in the conventional group（P<0.05）. The incidence of postoperative complications in the NOSES group was significantly lower than that in the conventional group（5.0% vs. 20.0%），and the difference was statistically significant（P<0.05）. ConclusionThe combination of ERAS and NOSES in laparoscopic treatment of left colorectal cancer has the advantages of less pain，fewer complications and faster recovery，which is worthy of clinical application.