Meng Xiangyu, Yang Dong, Zhang Bao, Yang Zhuo, Zhao Yan, Wang Danbo, Zhang Tao
Department of Gastric Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China.
Department of Gynecology, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China.
Wideochir Inne Tech Maloinwazyjne. 2023 Mar;18(1):77-89. doi: 10.5114/wiitm.2022.119239. Epub 2022 Sep 7.
Natural orifice specimen extraction (NOSE) laparoscopic surgery is emerging as a new and promising technique, especially in gastric cancer (GC).
To analyze the difference between transvaginal and transumbilical specimen extraction following totally laparoscopic gastrectomy (TLG).
Between January 2016 and July 2021, 37 consecutive female patients with GC who underwent either natural orifice specimen extraction surgery (NOSES) or TLG at our center were included and analyzed.
In total, 12 patients underwent NOSES, and 25 patients underwent TLG. The NOSES group had a shorter operative time (239.3 ±21.5 vs. 256.1 ±21.2 min, p = 0.031) and shorter specimen extraction time (17.0 ±4.2 vs. 30.8 ±4.3 min, p < 0.01). No significant difference was observed in the comparison of the radical validity including estimated blood loss, the number of harvested LNs and the comparisons of distal and proximal margin. In the postoperative recovery comparisons, the NOSES group had a shorter time to first fluids (3.9 ±0.5 vs. 5.6 ±1.2 days, p < 0.01), and time to starting a soft diet (5.6 ±0.7 vs. 7.7 ±1.7 days, p < 0.01). Postoperative pain in the NOSES group was significantly less. Postoperative hospital stay days in the NOSES group were fewer (10.2 ±2.2 vs. 12.4 ±2.9 days, p = 0.030). Overall, the postoperative complications were similar between the two groups (p = 0.438). When more cases were included, the results were similar. NOSES reduced hospital costs for GC patients, and it also applied to the premenopausal patients.
NOSES was a safer and more reliable method as compared to transumbilical specimen extraction.
经自然腔道标本取出术（NOSE）的腹腔镜手术正在成为一种新的且有前景的技术，尤其是在胃癌（GC）手术中。
分析全腹腔镜胃切除术（TLG）后经阴道与经脐标本取出术之间的差异。
2016年1月至2021年7月期间，本中心连续纳入37例行自然腔道标本取出术（NOSES）或TLG的女性GC患者并进行分析。
总共12例患者接受了NOSES，25例患者接受了TLG。NOSES组手术时间较短（239.3±21.5对256.1±21.2分钟，p = 0.031），标本取出时间较短（17.0±4.2对30.8±4.3分钟，p < 0.01）。在包括估计失血量、获取的淋巴结数量以及切缘远近端比较等根治有效性比较方面，未观察到显著差异。在术后恢复比较中，NOSES组首次进食流质时间较短（3.9±0.5对5.6±1.2天，p < 0.01），开始进食软食时间较短（5.6±0.7对7.7±1.7天，p < 0.01）。NOSES组术后疼痛明显较轻。NOSES组术后住院天数较少（10.2±2.2对12.4±2.9天，p = 0.030）。总体而言，两组术后并发症相似（p = 0.438）。纳入更多病例时，结果相似。NOSES降低了GC患者的住院费用，并且也适用于绝经前患者。
与经脐标本取出术相比，NOSES是一种更安全、更可靠的方法。
