经直肠标本取出的3D腹腔镜直肠前切除术治疗高龄直肠癌近期疗效分析

目的 分析经直肠标本取出的3D腹腔镜直肠前切除术治疗高龄直肠癌的近期疗效和安全可行性。方法 回顾性分析同济大学附属东方医院自2016年1月至2019年7月接受3D腹腔镜直肠前切除术的高龄组患者的临床资料，比较结直肠癌经自然腔道取标本手术（natural orifice specimen extraction surgery， NOSES）组和小切口手术（小切口手术组）患者手术、术后并发症及术后恢复等情况。结果 2组在肿瘤距下切缘距离、淋巴结清扫数、淋巴结阳性率、回肠造口率及术后第1天疼痛评分差异无统计学意义；但NOSES组的手术时间、术中出血量、术后肛门排气、进食、住院时间、并发症及术后第3天疼痛评分均明显优于小切口组（P＜0.05）。结论 NOSES腹腔镜直肠前切除术治疗高龄直肠癌的近期疗效与小切口组无差异，但术后恢复较快，并发症发生率低，值得临床推广。

Short-term outcomes of 3D laparoscopic anterior resection with transrectal extraction of specimen for elderly patients with rectal cancer

Objective To analyze the short-term efficacy, safety and feasibility of 3D laparoscopic anterior resection with transrectal extraction of specimen for elderly patients with rectal cancer. Methods Clinical data of 144 elderly patients with rectal cancer admitted in East Hospital Tongji University from January 2016 to July 2019 were retrospectively analysed. Among 144 cases, 63 received 3D laparoscopic natural orifice specimen extraction surgery(NOSES group) and 81 received small incision sp for ecimen extraction(small incision group). The short-term outcome, postoperative complications and postoperative recovery were compared between the NOSES group and the small incision group. Results Threr was no dignificant difference in tumor distance from the lower margin, number of dissected lymph nodes, lymph node positive rate, Ileostomy rate and postoperative first day pain score between two groups. But, the indicators of operation time, blood loss, exhaust time, postoperative eating time, postoperative hospital stay time, postoperative third day pain score and complications in the NOSES group were significantly better than those of the small incision group(P<0.05). Conclusion Three-D laparoscopic anterior resection with transrectal extraction of specimen has faster postoperative recovery and less complications for elderly patients with rectal cancer, which is worthy of clinical promotion.