三孔法经自然腔道标本取出术与传统腹腔镜直肠乙状结肠癌前切除术的配对分析

Three-Port with Natural Orifice Specimen Extraction versus Conventional Laparoscopic Anterior Resection for Rectal-Sigmoid Cancer: A Matched Pair Analysis.

作者信息

Zhou Haiyang, Wang Anqi, Lu Hao, Wu Jia, Ying Jun, Hu Zhiqian, Ruan Canping

机构信息

Division of Colorectal Surgery, Changzheng Hospital, Shanghai, P.R. China.

Division of General Practice Medicine, Changzheng Hospital, Shanghai, P.R. China.

出版信息

J Invest Surg. 2022 Apr;35(4):788-792. doi: 10.1080/08941939.2021.1956651. Epub 2021 Sep 20.

DOI:10.1080/08941939.2021.1956651

PMID:34542379

Abstract

BACKGROUND

The conventional laparoscopic colorectal surgery requires four or more ports to accomplish the laparoscopic dissection, and a mini-laparotomy to remove the specimen, which is a main cause of postoperative pain and incision complications, and compromise the cosmetic results. Reduced port surgery and natural orifice specimen extraction (NOSE) surgery hold the promise to overcome these drawbacks. This study planned to compare peri-operative outcomes of patients with rectal-sigmoid cancer undergoing three-port laparoscopic anterior resection with NOSE (three-port NOSE LAR) to those of patients receiving conventional LAR.

METHODS

Twenty-five patients with rectal-sigmoid cancer underwent three-port NOSE LAR between December 2018 and October 2020. For comparison, 50 patients with rectal-sigmoid cancer underwent conventional LAR in the same period were matched. The peri-operative outcomes were compared.

RESULTS

Operating time of three-port NOSE group was slightly longer than that of conventional group (135 min vs. 121 min, = .147). The incision length of three-port NOSE group was shorter than that of conventional group (2.9 cm vs. 7.4 cm, = .000). Complication rates in three-port NOSE group and conventional group were similar (12.0% vs. 20.0%, = .524). The tumor size was smaller in three-port NOSE group than the conventional group (2.1 cm vs. 3.5 cm, = .000). Pain score was lower in three-port NOSE group than the conventional group at postoperative day 1 (1.6 vs. 3.0, = 0.045) and day 2 (0.2 vs. 2.1, = .003). The BIQ score was significantly higher in the three-port NOSE group compared to the conventional group (42.9 ± 3.5 vs. 38.2 ± 2.5, = .002).

CONCLUSIONS

Three-port NOSE LAR for rectal-sigmoid cancer is feasible and provides similar peri-operative outcomes compared to conventional LAR. It reduces postoperative pain and produces better cosmesis.

摘要

背景

传统的腹腔镜结直肠癌手术需要四个或更多的端口来完成腹腔镜解剖，并需要一个小切口剖腹术来切除标本，这是术后疼痛和切口并发症的主要原因，并且影响美观效果。减少端口手术和经自然腔道标本取出术（NOSE）有望克服这些缺点。本研究计划比较接受三端口腹腔镜直肠癌前切除术联合NOSE（三端口NOSE LAR）的直肠乙状结肠癌患者与接受传统LAR的患者的围手术期结果。

方法

2018年12月至2020年10月期间，25例直肠乙状结肠癌患者接受了三端口NOSE LAR。为作比较，同期50例接受传统LAR的直肠乙状结肠癌患者进行了匹配。比较围手术期结果。

结果

三端口NOSE组的手术时间略长于传统组（135分钟对121分钟，P = 0.147）。三端口NOSE组的切口长度短于传统组（2.9厘米对7.4厘米，P = 0.000）。三端口NOSE组和传统组的并发症发生率相似（12.0%对20.0%，P = 0.524）。三端口NOSE组的肿瘤大小小于传统组（2.1厘米对3.5厘米，P = 0.000）。术后第1天（1.6对3.0，P = 0.045）和第2天（0.2对2.1，P = 0.003），三端口NOSE组的疼痛评分低于传统组。三端口NOSE组的BIQ评分显著高于传统组（42.9±3.5对38.2±2.5，P = 0.002）。