使用蔡氏管行腹腔镜辅助经自然腔道取标本左半结肠癌切除术的临床结局：一项前瞻性随机试验

Clinical outcomes of laparoscopic-assisted natural orifice specimen extraction colectomy using a Cai tube for left-sided colon cancer: a prospective randomized trial.

作者信息

Xu Shu-Zhen, Ding Zhi-Jie, Zhang Shi-Feng, Yuan Si-Bo, Yan Feng, Wang Zhen-Fa, Liu Guo-Yan, Cai Jian-Chun

机构信息

Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.

Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.

出版信息

Surg Endosc. 2023 Jan;37(1):749-758. doi: 10.1007/s00464-022-09435-z. Epub 2022 Jul 29.

DOI:10.1007/s00464-022-09435-z

PMID:35906459

Abstract

BACKGROUND

The role of laparoscopic-assisted natural orifice specimen extraction (LA-NOSE) colectomy in the treatment of left-sided colon cancer has not been well defined, and there remains confusion about how to conveniently exteriorize specimens through natural orifices. Therefore, we introduced a homemade invention, the Cai tube, to facilitate the extraction of specimens and compared the clinical outcomes of LA-NOSE with conventional laparoscopic (CL) colectomy for left-sided colon cancer.

METHODS

From March 2015 to August 2017, patients with left-sided colon cancer were randomly divided into LA-NOSE and CL groups. Specimens were extracted through the anus with the help of a Cai tube (Patent Number: ZL201410168748.2) in the LA-NOSE group. The primary outcome measure was postoperative pain. Secondary outcomes were the duration of operation, postoperative recovery, surgical morbidity, pathological quality of the specimen, and long-term outcomes, including 3-year overall survival, disease-free survival, local recurrence, and overall recurrence.

RESULTS

A total of 60 patients (30 per group) were recruited for this study. None of the patients required emergency conversion to conventional laparoscopic or open surgery during the operation. The postoperative maximum pain score was significantly lower in the LA-NOSE group (mean 2.5 vs. 5.1, P = 0.001), as was the additional analgesia requirement (mean 2/30 vs. 10/30, P = 0.021). Patients in the LA-NOSE group experienced a shorter first time to passage of flatus (mean 2.2 vs. 3.1 days, P = 0.026). All patients could control their defecation at 6 months after surgery. The comparison between the two groups showed no significant differences in the operative time, bleeding volume, postoperative hospital stay, surgical morbidity rates, number of lymph nodes harvested, or resection margin status. The mean follow-up was 48 months (range 7-59) and was similar in both groups. The results showed no differences in long-term outcomes between the two groups.

CONCLUSION

In the treatment of left-sided colon cancer, compared with conventional laparoscopic colectomy, LA-NOSE colectomy using the Cai tube exhibited lower postoperative pain, shorter recovery of gastrointestinal function, and similar long-term outcomes.

REGISTRATION NUMBER

ChiCTR-OOR-15007060 ( http://www.chictr.org.cn/ ).

摘要

背景

腹腔镜辅助经自然腔道取标本（LA-NOSE）结肠切除术在左侧结肠癌治疗中的作用尚未明确界定，且对于如何通过自然腔道方便地取出标本仍存在困惑。因此，我们引入了一项自制发明——蔡氏管，以促进标本的取出，并比较LA-NOSE与传统腹腔镜（CL）结肠切除术治疗左侧结肠癌的临床疗效。

方法

2015年3月至2017年8月，将左侧结肠癌患者随机分为LA-NOSE组和CL组。LA-NOSE组借助蔡氏管（专利号：ZL201410168748.2）经肛门取出标本。主要观察指标为术后疼痛。次要观察指标包括手术时间、术后恢复情况、手术并发症、标本的病理质量以及长期疗效，包括3年总生存率、无病生存率、局部复发率和总复发率。

结果

本研究共纳入60例患者（每组30例）。术中无患者需要紧急转为传统腹腔镜手术或开放手术。LA-NOSE组术后最大疼痛评分显著更低（平均2.5分对5.1分，P = 0.001），额外镇痛需求也更低（平均2/30对10/30，P = 0.021）。LA-NOSE组患者首次排气时间更短（平均2.2天对3.1天，P = 0.026）。所有患者术后6个月均可控制排便。两组在手术时间、出血量、术后住院时间、手术并发症发生率、清扫淋巴结数目或切缘情况方面比较，差异均无统计学意义。平均随访48个月（范围7 - 59个月），两组相似。结果显示两组长期疗效无差异。