Xu Shu-Zhen, Cai Jian-Chun
Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen Fujian, China; Institute of Gastrointestinal Oncology, Medical College of Xiamen University, Xiamen, Fujian, China; Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, China.
Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen Fujian, China; Institute of Gastrointestinal Oncology, Medical College of Xiamen University, Xiamen, Fujian, China; Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, China.
J Surg Res. 2022 Feb;270:31-38. doi: 10.1016/j.jss.2021.08.026. Epub 2021 Oct 7.
Laparoscopic-assisted natural orifice specimen extraction (LA-NOSE) gastrectomy effectively avoids the need for an abdominal incision, unlike conventional laparoscopic gastrectomy. In this study, we documented our experience with LA-NOSE gastrectomy using an auxiliary incision-free tube (Cai tube, a homemade invention: ZL201410168748.2) in 9 gastric cancer patients and summarized the clinical results.
From July 2018 to June 2020, a total of 9 patients with gastric cancer were recruited for this study. LA-NOSE gastrectomy (subtotal or total) using the auxiliary incision-free tube and D lymph node dissection were performed. Specimens were extracted through the anterior wall of the upper rectum in 4 male patients and the posterior fornix of the vagina in 5 female patients using the auxiliary incision-free tube.
All 9 patients underwent successful laparoscopic gastrectomy with NOSE using the auxiliary incision-free tube. No perioperative death, re-admission within 60 days post operation, natural orifice wound infection or tumor implantation was observed. The mean operating time was 365.3±41.7 min, and the mean estimated blood loss was 87.8±39.3 ml. The mean duration of hospital stay was 11.3±1.2 days, while the mean maximum pain score (visual analogue score, VAS) was 2.3±0.9 on postoperative day (POD) 1, and the mean time to ambulation was 1.3±0.5 days. The 60-day postoperative morbidity rate was 11.1% (1/9). After a mean follow-up of 14.7±9.6 months, there was no transrectal or transvaginal access-site recurrence, no anterior rectectomy or posterior fornix colpotomy-related complications, and no local recurrence or distant metastasis.
Our preliminary experience indicates that this new technique, LA-NOSE gastrectomy using the auxiliary incision-free tube, is feasible for selected patients with gastric cancer.
与传统腹腔镜胃切除术不同，腹腔镜辅助经自然腔道标本取出术（LA-NOSE）胃切除术有效避免了腹部切口的需要。在本研究中，我们记录了9例胃癌患者使用辅助免切口管（蔡氏管，一项自制发明：ZL201410168748.2）进行LA-NOSE胃切除术的经验，并总结了临床结果。
2018年7月至2020年6月，共招募9例胃癌患者进行本研究。采用辅助免切口管行LA-NOSE胃切除术（次全或全胃切除）及D组淋巴结清扫。4例男性患者通过直肠上段前壁、5例女性患者通过阴道后穹窿使用辅助免切口管取出标本。
所有9例患者均成功使用辅助免切口管行腹腔镜NOSE胃切除术。未观察到围手术期死亡、术后60天内再次入院、自然腔道伤口感染或肿瘤种植。平均手术时间为365.3±41.7分钟，平均估计失血量为87.8±39.3毫升。平均住院时间为11.3±1.2天，术后第1天平均最大疼痛评分（视觉模拟评分，VAS）为2.3±0.9，平均下床活动时间为1.3±0.5天。术后60天发病率为11.1%（1/9）。平均随访14.7±9.6个月后，未出现经直肠或经阴道入路部位复发、无直肠前切除术或阴道后穹窿切开术相关并发症，也无局部复发或远处转移。
我们的初步经验表明，这种新技术，即使用辅助免切口管的LA-NOSE胃切除术，对于选定的胃癌患者是可行的。
