Masubuchi Shinsuke, Okuda Junji, Yamamoto Masashi, Inoue Yoshihiro, Tanaka Keitaro, Uchiyama Kazuhisa
Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki 569-8686, Japan; Department of Gastroenterological Surgery, Hirakata City Hospital, Hirakata 573-1013, Japan.
Cancer Center, Osaka Medical College, Takatsuki 569-8686, Japan.
Int J Surg Case Rep. 2021 Jan;78:204-209. doi: 10.1016/j.ijscr.2020.12.059. Epub 2020 Dec 20.
In recent years, natural orifice specimen extraction (NOSE) has been attracting attention as a further minimally invasive operation for colorectal cancer, and not only improvement of appearance, but also reduction of pain and wound-related complications due to abdominal wall destruction has been reported. However, NOSE is technically complicated and difficult, and it has not yet been widely used. The aim of this study was to confirm the feasibility, safety, and short-term outcomes of total laparoscopic colon cancer surgery with NOSE.
From May 2018 to October 2019, eight patients with stage 0 or I colon cancer underwent NOSE surgery in our hospital. Transanal specimen extraction was performed in six cases, and transvaginal specimen extraction was performed in two cases. All operations were successfully accomplished without conversion to open surgery. The anastomosis method was double stapling technique in three cases and overlap method in five cases. The median operative time was 224 min. The median blood loss was 10 mL. The median time to first flatus was 1 day, and the median time to first stool was 2 days. The median postoperative observation period was 18 months, but there was no recurrence. There were no postoperative complications in these cases.
Total laparoscopic colon cancer surgery with NOSE appears to be feasible, safe, and show promising efficacy for selected patients.
近年来，经自然腔道标本取出术（NOSE）作为一种针对结直肠癌的进一步微创操作受到关注，据报道其不仅改善了外观，还减轻了疼痛以及因腹壁破坏导致的伤口相关并发症。然而，NOSE在技术上复杂且困难，尚未得到广泛应用。本研究的目的是证实全腹腔镜结肠癌手术联合NOSE的可行性、安全性及短期疗效。
2018年5月至2019年10月，我院8例0期或I期结肠癌患者接受了NOSE手术。6例经肛门取出标本，2例经阴道取出标本。所有手术均成功完成，未转为开放手术。吻合方法3例采用双吻合器技术，5例采用重叠法。中位手术时间为224分钟。中位失血量为10毫升。首次排气的中位时间为1天，首次排便的中位时间为2天。术后中位观察期为18个月，但无复发。这些病例均无术后并发症。
全腹腔镜结肠癌手术联合NOSE对特定患者似乎可行、安全且疗效良好。
