经直肠NOSES治疗结直肠癌术后近期临床疗效和生存质量分析

目的 研究经直肠NOSES术后患者短期肠道恢复、疼痛缓解等临床指标，明确NOSES治疗结直肠癌的短期临床疗效和生存质量。方法 选取2014年2月至2016年2月同济大学附属东方医院胃肠外科接诊的341例直肠癌患者为研究对象，采用随机对照研究方法分为3组： NOSES组(n=114例)、小切口组(n=121)、传统开腹组(n=106例)。分析比较术前及术后2周手术时间、术后出血，术后肠道功能恢复和术后并发症。通过VAS评分分析患者术后疼痛情况；通过SF-36生存质量表评估患者术前、术后1个月生存质量。结果 NOSES组患者腹部切口长度最小，术后VAS评分最低,差异有统计学意义(P<0.05)。3组患者性别、年龄、BMI、肿瘤距肛缘距离以及肿瘤T分期等术前资料比较差异均无统计学意义(P>0.05)。相比传统开腹组和小切口组(97.9±37.3mim、146.2±42.1min)，NOSES组手术时间最长(167.0±45.0min)差异有统计学意义（P<0.05)。与传统开腹组和小切口组相比，NOSES组术中出血量低、术后肛门初次排气时间较短、平均住院天数较少，差异均有统计学意义（P<0.05）。术后并发症发生率NOSES组与小切口组相比，差异具有统计学差异(P<0.05)。结论 相比于小切口腹腔镜和开腹手术，NOSES在术后并发症、快速康复和生活质量上具有明显优势，是值得推广的结直肠癌微创术式。

Short-term clinical efficacy and quality of life in patients with colorectal cancer after natural orifice specimen extraction surgery

Objective To evaluate the short-term recovery and quality of life in patients with colorectal cancer after laparoscopic transrectal natural orifice specimen extraction surgery(NOSES). Methods Total 341 patients with colorectal cancer admitted in Shanghai East Hospital between February 2014 and February 2016 were randomized into the NOSES(n=114), Lap non-NOSES(n=121), and open surgery(OS, n=106) groups. Preoperative and postoperative clinical variables(operation time, postoperative bleeding, postoperative intestinal function recovery and surgical complications) were analyzed and compared among the groups. Postoperative pain was analyzed utilizing a visual analog scale(VAS). Preoperative and one month postoperative quality of life was assessed with the SF-36 quality-of-life questionnaire. Results The NOSES group had the smallest abdominal incision and the lowest postoperative VAS score. No statistically significant differences in preoperative demographics of the patients(sex, age, body mass index) were found among the groups. The NOSES group had a little longer operation time. The OS group had a significantly higher blood loss than the NOSE group. The post-operative time for return to bowel function and the length of hospital stay(LOS) was statistically significantly different among the three groups, with the OS group having the longest time. The incidence of postoperative complications was lower in NOSES group than in that of the Lap non-NOSE group. Conclusion Comparing NOSE to Laparoscopic non-NOSE and open surgery, the NOSE has shorter time of postoperative recovery, lower surgical compliances and better quality of life for patients with colorectal cancer.