Zhang Xingmao, Zhou Haitao, Hou Huirong, Hu Junjie, Wang Hongying, Zhou Zhixiang
*Department of Gastrointestinal Surgery †The Overall Planning Office, Cancer Hospital ‡State Key Laboratory of Molecular Oncology, Cancer Institute and Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
J Clin Gastroenterol. 2014 Aug;48(7):e57-61. doi: 10.1097/MCG.0000000000000038.
To testify the feasibility and safety of an innovative technique we performed.
An abdominal incision is required to extract a specimen for laparoscopic-assisted colorectal operation, and the incision brings some disadvantages for surgeons and patients. Natural orifice specimen extraction (NOSE) is developed to avoid these disadvantages.
Between May 2012 and March 2013, we attempted to perform totally laparoscopic resection with NOSE in 27 patients with sigmoid colon cancer or rectal cancer. Procedure of this technique was described and clinic data of all 27 patients were collected and analyzed.
We successfully completed the technique of NOSE in 24 of these patients. Mean operation time was 110.0 minutes and mean intraoperative blood loss was 69.1 mL in 23 patients (not including one patient who received additional bilateral oophorectomy) who underwent NOSE. Of these 24 patients, the mean time to passing of first flatus was 3.1 days, the mean postoperative hospital stay was 9.2 days, and 2 patients used analgesics after operation; 22 patients were able to walk in first 2 days, 2 patients had postoperative complications.
Totally laparoscopic resection with NOSE is suited for selected patients with sigmoid colon cancer or rectal cancer, and this technique is worth to recommend and spread.
验证我们所实施的一项创新技术的可行性和安全性。
腹腔镜辅助结直肠手术需要腹部切口来取出标本，而该切口给外科医生和患者带来了一些不利之处。自然腔道标本取出术（NOSE）应运而生以避免这些弊端。
在2012年5月至2013年3月期间，我们尝试对27例乙状结肠癌或直肠癌患者实施完全腹腔镜切除术并采用NOSE。描述了该技术的操作过程，并收集和分析了所有27例患者的临床资料。
我们成功地对其中24例患者完成了NOSE技术。在接受NOSE的23例患者（不包括1例接受额外双侧卵巢切除术的患者）中，平均手术时间为110.0分钟，平均术中失血量为69.1毫升。在这24例患者中，首次排气的平均时间为3.1天，术后平均住院时间为9.2天，2例患者术后使用了镇痛药；22例患者在术后前两天能够行走，2例患者出现了术后并发症。
完全腹腔镜切除术联合NOSE适用于部分乙状结肠癌或直肠癌患者，该技术值得推荐和推广。
