不同手术操作方式在直肠癌NOSES手术中的临床应用研究

目的探讨不同手术操作方式在直肠癌经自然腔道取标本手术(NOSES)中的临床应用效果。 方法回顾性分析2017年9月至2019年5月行NOSES手术治疗的42例低位结直肠癌患者资料，根据手术操作方式不同将其分为Parks组和改良组，其中20例行Parks法结肠肛管吻合术(Parks组)，22例采用两步翻出直肠法联合改良式抵钉座绑线反穿吻合术(改良组)。选用SPSS 22.00统计软件进行数据分析。围术期各个指标以( ±s)表示，比较采用独立样本t检验；术后并发症发生率、Wexner失禁评分采用χ²或Fisher检验。P<0.05差异有统计学意义。 结果改良组下床活动时间、肛门排气时间、术后住院时间均明显少于Parks法组(P<0.05)；两组术后发生并发症、肿瘤复发率、远处转移率、Wexner评分改良组均优于Parks组，但差异均无统计学意义(P>0.05)。 结论两种手术操作方式在低位直肠癌NOSES手术中均安全可行，有较高的应用价值，但行两步翻出直肠法联合改良式抵钉座绑线反穿吻合术患者术后恢复更快。

Clinical application of different surgical methods in NOSES for rectal cancer

ObjectiveTo investigate the clinical effects of different surgical procedures in natural cavity sampling (NOSES) for rectal cancer. MethodsThe data of 42 patients with low colorectal cancer treated with NOSES in our hospital from September 2017 to May 2019 were retrospectively analyzed. They were divided into Parks method group(20 cases) and the modified group(22 cases) according to the different surgical procedures. SPSS 22.00 statistical software was used for data analysis.The perioperative indicators were expressed as ( ±s), Independent sample t test was used to compare. Postoperative complication rate and Wexner incontinence score were assessed using χ² or Fisher test. P<0.05 was statistically significant. ResultsThe time of getting out of bed, anal exhaust time and postoperative hospital stay in the modified group were significantly less than those in the Parks group (P<0.05). The postoperative complications, tumor recurrence rate, distant metastasis rate and Wexner score in the modified group were all better than the Parks group, but the differences were not statistically significant (P>0.05). ConclusionBoth of the two surgical methods are safe and feasible in NOSES for lower rectal cancer and have important clinical significance. However, patients who underwent two-step rectal resection combined with modified nail-to-nail binding line anastomosis had a faster recovery.