抵钉座经肛置入法腹部无切口手术与腹腔镜直肠前切除术的对比研究

  目的  探讨抵钉座经肛置入法腹部无切口手术（natural orifice specimen extraction surgery，NOSES）与腹腔镜直肠前切除术（laparoscopic anterior rectectomy，LAR）的临床效果比较。  方法  回顾性分析2019年1月至2020年1月在菏泽市立医院接受治疗的60例中低位直肠癌患者的临床资料，其中NOSES组（n=30）作为观察组行抵钉座经肛置入法肛门外翻切除标本腹部无切口手术，对照组（n=30）行LAR，对比分析两组术中和术后各临床相关指标。术后随访6~12个月，观察肿瘤复发情况。  结果  两组患者手术均顺利完成，无中转开腹病例，两组术中出血量、术中淋巴结清扫数目、术后并发症发生率、肿瘤复发率等差异无统计学意义（P>0.05）；NOSES组手术时间、术后疼痛评分、首次下床活动时间、肛门排气时间、首次进食时间、住院时间均优于对照组，差异有统计学意义（P<0.05）。  结论  NOSES治疗中低位直肠癌安全可行、效果满意。相比传统腹腔镜手术具有手术时间短、术后疼痛轻、下床活动早、肛门排气早、进食时间早、住院时间短、腹部无切口疤痕、快速康复等优点，而术后并发症及肿瘤复发率无明显增加，值得临床上推广应用。 

Comparative study of laparoscopic natural orifice specimen extraction surgery using aprolapsing technique and traditional laparoscopic rectectomy for middle and lowrectal cancer

  Objective  To investigate and compare the effect of laparoscopic natural orifice specimen extraction surgery (NOSES) using a prolapsing technique with that of traditional laparoscopic anterior rectectomy (LAR) for middle and low rectal cancer.  Methods  The clinical data of 60 rectal cancer patients admitted to Heze Municipal Hospital from January 2019 to January 2020 were retrospectively analyzed and compared. The patients were assigned equally into an observation group (treated with laparoscopic NOSES, n=30), and a control group (treated with traditional LAR, n=30). The patients were observed during a follow-up period of 6-12 months for tumor recurrence.  Results  All operations were successfully completed without conversion to laparotomy. There were no significant differences between the two groups in terms of intraoperative blood loss, number of harvested, lymphnodes, postoperative complications, and tumor recurrence rate (P>0.05). The observation group was significantly better than the control group in terms of operation time, pain index, time to ambulation, anal exhaust time, time to the first feeding and duration of hospital stay (P<0.05).  Conclusions  Complete laparoscopic NOSES for middle and low rectal cancer is feasible. Compared with traditional LAR, laparoscopic NOSES was associated with a shorter operation time, less pain, early ambulation, early anal exhaust, early feeding, shorter hospital stay, lack of auxiliary incision scar in the abdomen, and rapid rehabilitation. Postoperative complications and tumor recurrence rates did not increase significantly with this technique. Therefore the technique may be performed for eligible patients.