Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China.
J Laparoendosc Adv Surg Tech A. 2021 Nov;31(11):1227-1231. doi: 10.1089/lap.2020.0780. Epub 2020 Nov 9.
With the development of surgical technology, surgeons are paying more and more attention to minimally invasive procedures such as injury reduction, pain reduction, and beautiful incisions to ensure the effectiveness of surgical treatment. This article discusses the safety, feasibility, and clinical outcomes of laparoscopic resection of sigmoid colon and rectal tumors via natural orifice specimen extraction surgery (NOSES). The clinical data of 39 patients who underwent complete laparoscopic resection of sigmoid colon tumor or rectal tumor at Chengde Medical College Hospital between 2018 and 2020, including general patient data (gender, age, body mass index [BMI], etc.), surgery-related data, general postoperative conditions, and postoperative pathological data, were retrospectively analyzed to explore the feasibility and safety of NOSES. The specimens were all removed through the anorectal resection drag out type. The average age of 39 patients was 61.3 ± 10.2 years, the average BMI was 24.0 ± 3.1 kg/m, the average postoperative hospital stay was 11.2 ± 4.4 days, 12 patients with sigmoid colon tumors, including 11 malignant tumors and 1 schwannoma, 27 rectal tumors, including 1 rectal villous tubular adenoma, among the 37 patients with malignant tumors, ulcer type 32 cases of adenocarcinoma and 5 cases of mass adenocarcinoma, mean number of lymph nodes detected intraoperatively (11.9 ± 3.9), mean operative time (162.9 ± 43.0 minutes), mean operative bleeding (36.9 ± 13.0 mL), mean time of initial exhaust (4.3 ± 3.0) days, mean time of laparoscopic drainage tube removal (9.8 ± 1.4) days, mean time of postoperative feeding (4.4 ± 3.0) days, the average maximum tumor diameter (3.7 ± 1.4 cm), and the average distance of the tumor from the anal margin (14.1 ± 6.1 cm); after surgery, there were two cases of anastomotic fistula. Laparoscopic resection of sigmoid colon and rectal tumors via natural orifice specimen extraction has the advantages of less pain, reduced incisional complications, good safety, and accurate efficacy in clinical applications.
随着外科技术的发展，外科医生越来越关注微创程序，如减少损伤、减轻疼痛和美观的切口，以确保手术治疗的有效性。本文讨论了通过自然腔道标本提取手术（NOSES）进行腹腔镜乙状结肠和直肠肿瘤切除术的安全性、可行性和临床结果。回顾性分析了承德医学院附属医院 2018 年至 2020 年间完成的 39 例乙状结肠肿瘤或直肠肿瘤完全腹腔镜切除术患者的临床资料，包括一般患者资料（性别、年龄、体重指数[BMI]等）、手术相关数据、一般术后情况和术后病理资料，探讨了 NOSES 的可行性和安全性。标本均通过肛门直肠切除拖出式取出。39 例患者的平均年龄为 61.3±10.2 岁，平均 BMI 为 24.0±3.1kg/m，平均术后住院时间为 11.2±4.4 天，12 例乙状结肠肿瘤，包括 11 例恶性肿瘤和 1 例神经鞘瘤，27 例直肠肿瘤，包括 1 例直肠绒毛管状腺瘤，37 例恶性肿瘤患者中，溃疡型 32 例腺癌和 5 例肿块型腺癌，术中检测的平均淋巴结数（11.9±3.9）个，平均手术时间（162.9±43.0）分钟，平均手术出血量（36.9±13.0）mL，初次排气时间（4.3±3.0）天，腹腔镜引流管拔除时间（9.8±1.4）天，术后喂养时间（4.4±3.0）天，平均最大肿瘤直径（3.7±1.4cm），肿瘤距肛门边缘的平均距离（14.1±6.1cm）；术后吻合口瘘 2 例。腹腔镜乙状结肠和直肠肿瘤经自然腔道标本提取术具有疼痛少、切口并发症减少、安全性好、疗效准确的优点，在临床应用中有一定优势。
