Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Br J Surg. 2011 May;98(5):710-5. doi: 10.1002/bjs.7419. Epub 2011 Feb 8.
This case-control study compared the clinical outcomes of totally laparoscopic hemicolectomy with natural orifice specimen extraction (NOSE) and the conventional laparoscopically assisted approach for right-sided colonic cancer.
Consecutive patients who underwent totally laparoscopic mobilization of the right colon with transvaginal resection, anastomosis and specimen extraction between April 2007 and December 2009 were matched by various clinicopathological characteristics with patients who had conventional laparoscopically assisted procedures.
Thirty-four patients in each group were studied. The number of lymph nodes harvested and the resection margin status were similar in the two groups. After NOSE, patients experienced less pain (mean(s.e.m.) pain score on day 1: 4·2(0·3) versus 5·7(0·3), P = 0·001; on day 3: 2·6(0·2) versus 3·5(0·2), P = 0·010) and had a shorter hospital stay (mean(s.d.) 7·9(0·8) versus 8·8(1·5) days; P = 0·003). The NOSE group had less surgical morbidity than the laparoscopically assisted group, but the difference was not significant (4 of 34 versus 9 of 34; P = 0·119). After a median follow-up of 23 (range 5-40) months, there was no transvaginal access-site recurrence or posterior colpotomy-related complications. NOSE was associated with significantly better cosmetic results (mean(s.d.) score 7·5(1·7) versus 6·6(1·8); P = 0·037).
The NOSE approach is feasible with favourable short-term surgical outcomes.
本病例对照研究比较了经阴道切除吻合和标本提取的全腹腔镜右半结肠切除术（NOSE）与传统腹腔镜辅助方法治疗右侧结肠癌的临床效果。
2007 年 4 月至 2009 年 12 月，连续对 34 例行全腹腔镜右半结肠游离、经阴道切除吻合和标本提取的患者进行了研究，按各种临床病理特征与同期行传统腹腔镜辅助手术的 34 例患者进行了匹配。
两组患者的淋巴结清扫数量和切缘状态相似。NOSE 后患者疼痛程度较轻（术后第 1 天的平均（标准差）疼痛评分：4.2（0.3）比 5.7（0.3），P = 0.001；术后第 3 天：2.6（0.2）比 3.5（0.2），P = 0.010），住院时间较短（平均（标准差）住院时间：7.9（0.8）比 8.8（1.5）天；P = 0.003）。NOSE 组的手术并发症发生率低于腹腔镜辅助组，但差异无统计学意义（34 例中有 4 例比 34 例中有 9 例；P = 0.119）。中位随访 23 个月（范围 5-40 个月）时，无经阴道通道部位复发或后阴道切开术相关并发症。NOSE 组的美容效果明显更好（平均（标准差）评分：7.5（1.7）比 6.6（1.8）；P = 0.037）。
NOSE 方法可行，短期手术效果良好。
