Hu Jun-Hong, Li Xing-Wang, Wang Chen-Yu, Zhang Jun-Jie, Ge Zheng, Li Bing-Hui, Lin Xu-Hong
Department of Anorectal Surgery, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China.
Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China.
World J Clin Cases. 2019 Jan 26;7(2):122-129. doi: 10.12998/wjcc.v7.i2.122.
This case-control study compared the short-term clinical efficacy of natural orifice specimen extraction surgery (NOSES) using a prolapsing technique and the conventional laparoscopic-assisted approach for low rectal cancer.
To further explore the application value of the transanal placement of the anvil and to evaluate the short-term efficacy of NOSES for resecting specimens of low rectal cancer, as well as to provide a theoretical basis for its extensive clinical application.
From June 2015 to June 2018, 108 consecutive laparoscopic-assisted low rectal cancer resections were performed at our center. Among them, 26 specimens were resected transanally using a prolapsing technique (NOSES), and 82 specimens were resected through a conventional abdominal wall small incision (LAP). A propensity score matching method was used to select 26 pairs of matched patients, and their perioperative data were analyzed.
The baseline data were comparable between the two matched groups. All 52 patients underwent the surgery successfully. The operative time, blood loss, number of harvested lymph nodes, postoperative complication rate, circumferential margin involvement, postoperative follow-up data, and postoperative anal function were not statistically significant. The NOSES group had shorter time to gastrointestinal function recovery (2.6 ± 1.0 d 3.4 ± 0.9 d, = 0.006), shorter postoperative hospital stay (7.1 ± 1.7 d 8.3 ± 1.1 d, = 0.003), lower pain score (day 1: 2.7 ± 1.8 4.6 ± 1.9, day 3: 2.0 ± 1.1 4.1 ± 1.2, day 5: 1.7 ± 0.9 3.3 ± 1.0, < 0.001), a lower rate of additional analgesic use (11.5% 61.5%, = 0.001), and a higher satisfaction rate in terms of the aesthetic appearance of the abdominal wall after surgery (100% 23.1%, < 0.001).
NOSES for low rectal cancer can achieve satisfactory short-term efficacy and has advantages in reducing postoperative pain, shortening the length of postoperative hospital stay, and improving patients' satisfaction in terms of a more aesthetic appearance of the abdominal wall.
本病例对照研究比较了采用脱垂技术的经自然腔道标本取出手术（NOSES）与传统腹腔镜辅助方法治疗低位直肠癌的短期临床疗效。
进一步探讨吻合器经肛门置入的应用价值，评估NOSES治疗低位直肠癌标本切除的短期疗效，为其临床广泛应用提供理论依据。
2015年6月至2018年6月，我院中心连续进行了108例腹腔镜辅助低位直肠癌切除术。其中，26例标本采用脱垂技术经肛门切除（NOSES组），82例标本通过传统腹壁小切口切除（LAP组）。采用倾向评分匹配法选择26对匹配患者，并分析其围手术期数据。
两组匹配患者的基线数据具有可比性。所有52例患者均成功完成手术。手术时间、出血量、清扫淋巴结数目、术后并发症发生率、环周切缘受累情况、术后随访数据及术后肛门功能差异均无统计学意义。NOSES组胃肠道功能恢复时间较短（2.6±1.0天比3.4±0.9天，P = 0.006），术后住院时间较短（7.1±1.7天比8.3±1.1天，P = 0.003），疼痛评分较低（术后第1天：2.7±1.8比4.6±1.9，术后第3天：2.0±1.1比4.1±1.2，术后第5天：1.7±0.9比3.3±1.0，P<0.001），额外使用镇痛药的比例较低（11.5%比61.5%，P = 0.001），术后腹壁美观满意度较高（100%比23.1%，P<0.001）。
低位直肠癌NOSES手术可获得满意的短期疗效，在减轻术后疼痛、缩短术后住院时间及提高患者对腹壁美观度的满意度方面具有优势。
