Fang-Hai Han, Li-Xin Hua, Zhi Zhao, Jian-Hai Wu, Wen-Hua Zhan, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China.
World J Gastroenterol. 2013 Nov 21;19(43):7751-7. doi: 10.3748/wjg.v19.i43.7751.
To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.
A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal cancer with various tumor-node-metastasis classifications from March 2011 to February 2012 at the First Affiliated Hospital of Sun Yat-Sen University was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of tumor size and distance of rectal lesions from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed.
None of the patients was converted to laparotomy. Respectively, there were 16 cases in the low anastomosis and five in the ultralow anastomosis groups. Mean age of the patients was 45.4 years, and mean body mass index was 23.1 kg/m². Mean distance of the lower edge of the lesion from the anal verge was 8.3 cm. Mean operating time was 132 min, and mean intraoperative blood loss was 84 mL. According to the principle of rectal cancer surgery, we performed D2 lymph node dissection in 13 cases and D3 in eight. Mean lymph nodes harvest was 17.8, and the number of positive lymph nodes was 3.4. Median hospital stay was 6.7 d. No serious postoperative complication occurred except for one anastomotic leakage. All patients remained disease free. Mean Wexner score was 3.7 at 11 mo after the operation.
Transanal NOSE for total laparoscopic low/ultralow anterior resection is feasible, safe and oncologically sound. Further studies with long-term outcomes are needed to explore its potential advantages.
探讨经肛门自然腔道取标本（NOSE）是否是直肠肿瘤切除的更好技术。
分析中山大学附属第一医院 2011 年 3 月至 2012 年 2 月连续系列接受腹腔镜低位前切除术治疗不同肿瘤-淋巴结-转移分期的直肠肿瘤患者的前瞻性设计数据库。根据肿瘤大小和直肠病变距肛缘的距离选择经肛门标本提取和腔内吻合的患者。评估人口统计学数据、手术参数和术后结果。
无一例患者转为剖腹手术。低位吻合组分别有 16 例，超低吻合组有 5 例。患者平均年龄为 45.4 岁，平均体重指数为 23.1kg/m²。病变下缘距肛缘平均距离为 8.3cm。平均手术时间为 132 分钟，术中出血量为 84 毫升。根据直肠癌手术原则，我们在 13 例中进行 D2 淋巴结清扫，8 例中进行 D3 淋巴结清扫。平均淋巴结检出数为 17.8 个，阳性淋巴结数为 3.4 个。中位住院时间为 6.7d。除一例吻合口漏外，无严重术后并发症。所有患者均无疾病复发。术后 11 个月平均 Wexner 评分为 3.7。
全腹腔镜低位/超低位前切除术经肛门自然腔道取标本是可行的、安全的和肿瘤学上合理的。需要进一步的长期研究来探索其潜在的优势。
