腹部无辅助切口经阴道拖出标本在女性腹腔镜高位直肠癌手术中的应用

目的:探讨腹部无辅助切口经阴道拖出标本的腹腔镜下高位直肠癌根治术的安全性、可行性与近期临床疗效。方法:于2015年1月至2019年1月期间在中国医学科学院北京协和医学院肿瘤医院结直肠外科接受腹部无辅助切口经阴道拖出标本的腹腔镜高位直肠癌根治术（NOSES组）的患者共28例，采用1∶2配对设计，获得同时期接受传统腹腔镜高位直肠癌根治术（传统腹腔镜组）56例。采用回顾性队列研究的方法，收集分析两组患者的临床病理资料。结果:比较两组患者年龄、体质指数、美国麻醉医师学会（ASA）评分、腹部手术史、肿瘤大小、肿瘤病理学分期（pTNM）等基本资料，结果提示两组间无统计学差异(P＞0.05)。NOSES组手术时间（124.3±18.3）min，术中出血量（67.3±58.8）ml；传统腹腔镜组手术时间（133.5±16.4）min，术中出血量（62.5±51.2）ml。两组在手术时间、出血量、首次排气时间、术后并发症、淋巴结清扫数量方面亦无统计学差异（均P＞0.05）。而相比于传统腹腔镜组，NOSES组患者术后住院时间短（P=0.042）、术后第一日（P＜0.001）与第二日（P=0.013）疼痛程度明显较低。结论:腹部无辅助切口经阴道拖出标本的腹腔镜高位直肠癌根治术是安全可行的。具有手术创伤小、患者恢复速度快等优势，并可取得令人满意的近期疗效。

The application of laparoscopic transvaginal specimen extraction surgery without abdominal auxiliary incision for high rectal cancer in females

Objective:To investigate the safety,feasibility and short-term clinical effect of laparoscopic transvaginal specimen extraction surgery without abdominal auxiliary incision for high rectal cancer.Methods:A total of 28 patients underwent laparoscopic transvaginal specimen extraction surgery without abdominal auxiliary incision for high rectal cancer (NOSES group) at Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from January 2015 to January 2019.1∶2 pairing design was used.A total of 56 cases who underwent traditional laparoscopic resection for high rectal cancer (traditional laparoscopy group) were obtained.Retrospective cohort study was conducted to collect and analyze the clinicopathological data of the two groups of patients.Results:Age,body mass index,ASA score,abdominal surgery history,tumor size,tumor pathological stage (pTNM) and other basic data were compared between the two groups,and the results showed no statistical difference between the two groups (P＞0.05).The operative time of NOSES group was (124.3±18.3) min,and the intraoperative blood loss was (67.3±58.8) ml.The operative time of the traditional laparoscopy group was (133.5±16.4) min,and the intraoperative blood loss was (62.5±51.2) ml.There were no significant differences between the two groups in terms of operation time,blood loss,first exhaust time,postoperative complications and number of lymph node dissection (all P＞0.05).Compared with the traditional laparoscopy group,patients in the NOSES group had shorter postoperative hospital stay (P=0.042),significantly lower pain on the first postoperative day (P＜0.001) and the second postoperative day (P=0.013).Conclusion:Laparoscopic transvaginal specimen extraction surgery without abdominal auxiliary incision for high rectal cancer is safe and feasible.It has the advantages of less surgical trauma,rapid recovery and satisfactory short-term efficacy.