Maoxi Liu, Xingyu Guo, Wenqi Bai, Bo Jiang
Department of Colorectal Surgery, Shanxi Provincial Cancer Hospital, Taiyuan, China.
Front Surg. 2022 Sep 7;9:972258. doi: 10.3389/fsurg.2022.972258. eCollection 2022.
Analysis of the clinical efficacy of the application of the NOSES I-type E method combined with 3D laparoscopy in sphincter-preserving surgery of low rectal cancer.
A retrospective analysis of 109 patients who underwent laparoscopic low rectal cancer surgery for anus preservation without preventive stoma admitted to the Department of Colorectal Surgery in Shanxi Provincial Cancer Hospital between January 2017 and May 2019. The 109 cases comprised 52 cases treated with the NOSES I-type E method (NOSES I-type E group) and 57 cases treated with the Dixon method (Dixon group). In the NOSES I-type E group, 25cases underwent 3D laparoscopic surgery (group A) and 27 cases underwent 2D laparoscopic surgery (group B). The general clinical data, perioperative indicators, three-day postoperative pain score, postoperative pathological conditions, complications, return visit to assess the 1-year postoperative anal function, 3-year local recurrence and distant metastasis, and survival were compared among the groups.
The distance between the tumor and the anal verge was significantly different between NOSES I-type E group and the Dixon group (<0.05), while there was no significant difference between group A and group B (> 0.05). The exhaust time, eating time, drainage tube removal time, hospitalization costs, hospitalization time, and the number of days of analgesic administration were significantly different between NOSES I-type E group and the Dixon group (< 0.05), while group A had no significant difference compared to group B (> 0.05). There were significant differences in difficulty urinating between group A and B (< 0.05), while there was no significant difference between NOSES I-type E group and the Dixon group ( > 0.05). Anastomotic leakage in NOSES I-type E group were significantly lower than those in the Dixon group (< 0.05), while there was no significant difference between group A compared to group B (> 0.05). Anal stenosis, rectal Prolapse and colon retraction in NOSES I-type E group were significantly higher than those in Dixon group (<0.05), there was no significant difference between group A compared to group B (> 0.05). Anastomotic bleeding in Dixon group occurred in higher frequency than in NOSES I-type E group (<0.05). The pain scores of patients in NOSES I-type E group in the first three days after operation were significantly lower than those in Dixon group (< 0.05),while there was no significant difference between group A and group B (> 0.05). There were no significant differences in postoperative pathology, 1-year postoperative anal function score, 3-year recurrence rate and overall survival rate among the groups (>0.05).
The NOSES I-type E method is a safe and effective sphincter-preserving operation for low rectal cancer and its combination with 3D laparoscopy may have better neurological protection which is worth of clinical application.
分析NOSES I型E法联合3D腹腔镜在低位直肠癌保肛手术中的临床疗效。
回顾性分析2017年1月至2019年5月山西省肿瘤医院结直肠外科收治的109例行腹腔镜低位直肠癌保肛手术且未行预防性造口的患者。109例患者中，52例采用NOSES I型E法治疗（NOSES I型E组），57例采用Dixon法治疗（Dixon组）。在NOSES I型E组中，25例接受3D腹腔镜手术（A组），27例接受2D腹腔镜手术（B组）。比较各组的一般临床资料、围手术期指标、术后3天疼痛评分、术后病理情况、并发症、术后1年肛门功能回访评估、3年局部复发和远处转移情况以及生存率。
NOSES I型E组与Dixon组肿瘤距肛缘距离差异有统计学意义（<0.05），而A组与B组间差异无统计学意义（>0.05）。NOSES I型E组与Dixon组排气时间、进食时间、引流管拔除时间、住院费用、住院时间及镇痛给药天数差异有统计学意义（<0.05），而A组与B组比较差异无统计学意义（>0.05）。A组与B组排尿困难差异有统计学意义（<0.05），而NOSES I型E组与Dixon组间差异无统计学意义（>0.05）。NOSES I型E组吻合口漏发生率明显低于Dixon组（<0.05），而A组与B组比较差异无统计学意义（>0.05）。NOSES I型E组肛门狭窄、直肠脱垂及结肠回缩发生率明显高于Dixon组（<0.05），A组与B组比较差异无统计学意义（>0.05）。Dixon组吻合口出血发生率高于NOSES I型E组（<0.05）。NOSES I型E组患者术后前3天疼痛评分明显低于Dixon组（<0.05），而A组与B组比较差异无统计学意义（>0.05）。各组术后病理、术后1年肛门功能评分、3年复发率及总生存率差异无统计学意义（>0.05）。
NOSES I型E法是一种安全有效的低位直肠癌保肛手术方法，其联合3D腹腔镜可能具有更好的神经保护作用，值得临床应用。
