Hiep P N, Thien H H, Vu P A, Thanh P H, Xuan N T
Department of Paediatric and Abdominal Emergency Surgery Hue Central Hospital Hue Vietnam.
Hue University of Medicine and Pharmacy Hue Vietnam.
BJS Open. 2017 May 24;1(1):24-29. doi: 10.1002/bjs5.4. eCollection 2017 Feb.
Natural orifice transluminal endoscopic surgery (NOTES) has theoretical advantages over other approaches.
This was a prospective cohort study of colorectal cancers operated on by NOTES (transanally for rectal tumours, transvaginally for sigmoid tumours) between December 2013 and December 2015, with a minimum follow-up of 1 year. Eligibility criteria included ASA fitness grade I-III, BMI below 25 kg/m and TNM stage T3 N0 M0. Exclusion criteria included pregnancy or distant metastasis. The anastomosis was either handsewn or performed mechanically.
Sixteen patients were operated on by a transanal and four by a transvaginal approach. There were ten men and ten women, with a mean(s.d.) age of 55·6(12·1) years. Mean BMI was 22·4(2·6) kg/m. Four anterior, 11 low anterior and five intersphincteric resections were performed for 16 rectal and four low sigmoid tumours. The mean duration of surgery was 258(11) min. No conversion to laparotomy was needed, and there were no deaths. Five patients required additional ports, for intraoperative bleeding (1), suture of an intraoperative urethral injury with covering ileostomy (1) and difficulty in dissection (3). One patient had an anastomotic leak requiring transanal closure and ileostomy on day 7. Both ileostomies were closed after 2 months. The mean hospital stay was 6·4(1·8) days. All resections were R0.
In carefully selected patients NOTES for colorectal cancer resection was feasible and effective.
经自然腔道内镜手术（NOTES）相对于其他手术方式具有理论优势。
这是一项前瞻性队列研究，研究对象为2013年12月至2015年12月期间接受NOTES手术（经肛门切除直肠肿瘤，经阴道切除乙状结肠肿瘤）的结直肠癌患者，最短随访时间为1年。纳入标准包括美国麻醉医师协会（ASA）身体状况分级为I - III级、体重指数（BMI）低于25kg/m²以及TNM分期为T3 N0 M0。排除标准包括妊娠或远处转移。吻合方式采用手工缝合或机械吻合。
16例患者接受经肛门手术，4例接受经阴道手术。男性10例，女性10例，平均（标准差）年龄为55.6（12.1）岁。平均BMI为22.4（2.6）kg/m²。对16例直肠肿瘤和4例低位乙状结肠肿瘤进行了4例前切除术、11例低位前切除术和5例括约肌间切除术。平均手术时间为258（11）分钟。无需中转开腹，无死亡病例。5例患者因术中出血（1例）、术中尿道损伤缝合并覆盖回肠造口（1例）及解剖困难（3例）需要额外置入端口。1例患者发生吻合口漏，于术后第7天需经肛门闭合及行回肠造口术。2个月后回肠造口均关闭。平均住院时间为6.4（1.8）天。所有切除标本均为R0切除。
对于精心挑选的患者，NOTES用于结直肠癌切除是可行且有效的。
