经肛门取标本手术与常规腹腔镜手术在左半结肠癌中的近期疗效对比

Comparative study on the short-term efficacy of transanal natural orifice specimen extraction surgery and conventional laparoscopic surgery in left-sided colon cancer

摘要:

目的 对比经自然腔道（肛门）取标本手术（Ta-NOSES）与常规腹腔镜手术在左半结肠癌中的近期疗效与安全性。方法 回顾性分析该院肛肠病区2018年1月－2019年12月收治的35例左半结肠癌患者的临床资料，按照手术方法的不同，将患者分为实验组（15例）和对照组（20例），实验组行Ta-NOSES，对照组行常规腹腔镜手术。比较两组患者围手术期相关指标、术后并发症、术后疼痛评分、术后排便控制情况、术后近期生活质量评分和术后5年随访情况。结果 两组患者术中出血量、造口状态和淋巴结清扫数量比较，差异均无统计学意义（P > 0.05），且两组患者均未出现永久性造口；实验组手术时间较对照组长，首次下床活动时间、首次肛门排气时间、首次进食时间和住院时间较对照组短，住院费用较对照组低，差异均有统计学意义（P < 0.05）；术后1和3 d，实验组VAS评分明显低于对照组，术后3 d，两组患者VAS评分明显低于术后1 d，差异均有统计学意义（P < 0.05）。两组患者术后Kirwan肛门功能分级比较，差异有统计学意义（P < 0.05），实验组分级较好（Ⅰ级比例更高），对照组分级较差（Ⅱ级、Ⅲ级和Ⅳ级比例更高）。而两组患者术后并发症比较，差异无统计学意义（P > 0.05）。实验组患者术后10和20 d的健康调查量表36（SF-36）各项目评分均高于对照组（P<0.05），两组患者术后30 d SF-36各项目评分比较，差异均无统计学意义（P > 0.05）。实验组术后远处复发率为26.7%，与对照组的25.0%比较，差异无统计学意义（P > 0.05）；两组均无原切口部位、直肠肠腔和盆腔等标本取出途径的肿瘤复发病例，实验组5年生存率为73.3%，与对照组的70.0%比较，差异无统计学意义（P > 0.05）。结论 Ta-NOSES治疗左半结肠癌较常规腹腔镜手术能够减轻术后疼痛，促进术后胃肠功能恢复，提高医疗资源利用率，减轻患者经济负担，改善术后近期生活质量，且不增加术后并发症的发生风险和肿瘤转移复发风险。值得临床推广应用。

Abstract:

Objective To compare the short-term efficacy and safety of transanal natural orifice specimen extraction surgery (Ta-NOSES) and conventional laparoscopic surgery in left-sided colon cancer.Methods A retrospective analysis was conducted on the clinical data of 35 patients with left-sided colon cancer admitted to the anorectal department of the hospital from January 2018 to December 2019. According to the different surgical methods, the patients were divided into experimental group (15 cases) and control group (20 cases). The observation group underwent Ta-NOSES, and the control group underwent conventional laparoscopic surgery. The perioperative related indicators, postoperative complications, postoperative pain scores, postoperative defecation control, short-term postoperative quality of life scores and 5-year postoperative follow-up of the two groups of patients were compared.Results There was no statistically significant difference in the intraoperative blood loss, stoma status and the number of lymph node dissections between the two groups of patients (P > 0.05). Moreover, no permanent stoma occurred in either group of patients. The operation time of the experimental group was longer than that of the control group, the first time to get out of bed and move around, the time of the first anal exhaust, the time of the first diet intake and the hospital stay were shorter than those of the control group, the hospitalization cost was significantly lower than that of the control group, the differences were statistically significant (P < 0.05). On 1 and 3 days after operation, the VAS scores of the experimental group were significantly lower than those of the control group. At 3 days after operation, the VAS scores of the two groups were significantly lower than those at 1 day after operation, and the differences were statistically significant (P < 0.05).There was a statistically significant difference in postoperative Kirwan anal function grading between two groups of patients (P < 0.05), with the experimental group having a better grading (higher proportion of grade I), the control group had poor grading (with a higher proportion of grades Ⅱ, Ⅲ, and Ⅳ). There was no statistically significant difference in postoperative complications between the two groups of patients (P > 0.05). The scores of each item on the Short Form-36 (SF-36) in the experimental group were higher than those in the control group at 10 and 20 days after surgery (P < 0.05). There was no statistically significant difference in the scores of each item on the SF-36 between the two groups at 30 days after surgery (P > 0.05).The distant recurrence rate after surgery in the experimental group was 26.7%,compared with 25.0% in the control group, the difference was not statistically significant (P > 0.05). There were no tumor recurrence cases with the original incision site, rectal and intestinal cavity, pelvic cavity and other specimen removal routes in both groups. The 5-year survival rate of the experimental group was 73.3%, which was not statistically significantly different from that of the control group (70.0%) (P > 0.05).Conclusion Ta-NOSES in the treatment of left-sided colon cancer can alleviate postoperative pain compared with conventional laparoscopic surgery, promote the recovery of postoperative gastrointestinal function, improve the utilization rate of medical resources, reduce the economic burden of patients, improve the short-term quality of life after surgery, and does not increase the risks of postoperative complications and tumor metastasis and recurrence. It is worthy of clinical promotion and application.