Kim Hye Jin, Choi Gyu-Seog, Park Jun Seok, Park Soo Yeun, Ryuk Jong Pil, Yoon Sung Hwan
Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hogukno, Buk-gu, Daegu, 702-210, Korea.
Surg Endosc. 2014 Aug;28(8):2342-8. doi: 10.1007/s00464-014-3466-1. Epub 2014 Feb 25.
Although the vagina is considered a viable route during laparoscopic surgery, a number of concerns have led to a need to demonstrate the safety of a transvaginal approach in colorectal surgery. However, the data for transvaginal access in left-sided colorectal cancer are extremely limited, and no study has compared the clinical outcomes with a conventional laparoscopic procedure.
We compared the clinical outcomes of totally laparoscopic anterior resection with transvaginal specimen extraction (TVSE) with those of the conventional laparoscopic approach with minilaparotomy (LAP) for anastomosis construction and specimen retrieval in left-sided colorectal cancer.
Fifty-eight patients underwent TVSE between October 2006 and July 2011 and were matched by age, surgery date, tumor location, and tumor stage with patients who underwent conventional LAP for left-sided colorectal cancer.
Operative time was significantly longer in the TVSE group (149.3 ± 39.8 vs. 131.9 ± 41.4 min; p = 0.023). Patients in the TVSE group experienced less pain (pain score 4.9 ± 1.6 vs. 5.8 ± 1.9; p = 0.008), shorter time to passage of flatus (2.2 ± 1.1 vs. 2.7 ± 1.2 days; p = 0.026), and higher satisfaction with the cosmetic results (cosmetic score 8.0 ± 1.4 vs. 6.3 ± 1.5; p = 0.001). More endolinear staplers for rectal transection were used in the LAP group (1.2 ± 0.5 vs. 1.1 ± 0.2; p = 0.021). Overall morbidities were similar in both groups; however, three wound infections only occurred in the LAP group. After a median follow-up of 34.4 (range 11-60) months, no transvaginal access-site recurrence occurred. The 3-year disease-free survival was similar between groups (91.5 vs. 90.8%; p = 0.746).
Transvaginal access after totally laparoscopic anterior resection is safe and feasible for left-sided colorectal cancer in selected patients with better short-term outcomes.
尽管阴道被认为是腹腔镜手术的一条可行路径，但一些担忧促使有必要证明经阴道途径在结直肠手术中的安全性。然而，左侧结直肠癌经阴道入路的数据极为有限，且尚无研究将其临床结果与传统腹腔镜手术进行比较。
我们比较了完全腹腔镜下前切除术经阴道取出标本（TVSE）与传统腹腔镜联合小切口剖腹术（LAP）在左侧结直肠癌吻合口构建及标本取出方面的临床结果。
2006年10月至2011年7月期间，58例患者接受了TVSE手术，并根据年龄、手术日期、肿瘤位置和肿瘤分期与接受传统LAP手术的左侧结直肠癌患者进行匹配。
TVSE组手术时间显著更长（149.3±39.8对131.9±41.4分钟；p = 0.023）。TVSE组患者疼痛较轻（疼痛评分4.9±1.6对5.8±1.9；p = 0.008），排气时间较短（2.2±1.1对2.7±1.2天；p = 0.026），对美容效果的满意度更高（美容评分8.0±1.4对6.3±1.5；p = 0.001）。LAP组用于直肠横断的直线切割吻合器更多（1.2±0.5对l.1±0.2；p = 0.021）。两组总体并发症相似；然而，仅LAP组发生了3例伤口感染。中位随访34.4（范围11 - 60）个月后，未发生经阴道入路部位复发。两组3年无病生存率相似（91.5%对90.8%；p = 0.746）。
对于部分患者，完全腹腔镜下前切除术后经阴道入路在左侧结直肠癌手术中是安全可行的，且短期结果更佳。
