摘要
探讨通过改良结直肠癌经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)无菌无瘤操作的技术要点,使之更能融合加速康复外科(enhanced recovery after surgery,ERAS)其主张术前不进行常规肠道准备等理念。入组2018年7月浙江省台州医院胃肠外科一例乙状结肠癌患者,采取NOSESⅣ型改良手术联合实施加速康复路径。该患者顺利完成手术,手术时间140 min,术中出血量20 mL。术后顺利按快速康复路径恢复饮食,胃肠功能恢复顺利,无相关并发症发生,于6 d内康复出院。从本案例来看,实施NOSES手术联合加速康复理念是可行的,只要在手术操作环节上作出改良,不仅能从根源上最大可能避免腹部切口感染,减小患者手术创伤,减轻患者术后切口疼痛,也让ERAS理念得以实施,并在术后恢复上体现出一定的优势:该患者术后直至出院未应用肠外营养,术后当天即进行全流质饮食,术后当天进行运动,术后出院时间6 d内,术后随访18个月余未见复发,整体上看近期疗效满意,为后续NOSES手术联合加速康复理念研究提供临床资料支持。
To make natural orifice specimen extraction surgery(NOSES)more integrated with the concept of enhanced recovery after surgery(ERAS)that does not require routine bowel preparation before surgery by modifying the technical points of aseptic and tumor-free operation of NOSES.A patient with sigmoid cancer treated in gastrointestinal surgery of our hospital in July 2018 was treated with NOSES typeⅣmodified surgery combined with ERAS.The patient completed the operation successfully,the operation duration was 140 minutes,and the intraoperative blood loss was 20 mL.After the operation,the diet was resumed smoothly following ERAS,the gastrointestinal function recovered smoothly,and no related complications occurred.The patient recovered and was discharged from hospital within 6 days.It is proved by this case that it is feasible to implement the concept of NOSES surgery combined with ERAS provided improvements are made in the operation procedure.It can not only ultimately avoid the abdominal incision infection,reduce the surgical trauma of the patient,relieve the pain of the incision,but also realize the ERAS concept.There are certain advantages demonstrated in postoperative recovery:the patient was not required parenteral nutrition after surgery till discharge;the patient was given a full-liquid diet and exercised on the day after operation;the patient was discharged within 6 days after surgery;there was no recurrence during the 18 months follow-up after operation.Overall,the short-term efficacy was satisfactory.It provided clinical data support for the further study of the concept of NOSES surgery combined with ERAS.
作者
刘帅
江良县
毕铁男
周申康
LIU Shuai;JIANG Liangxian;BI Tienan;ZHOU Shenkang(Department of Gastrointestinal Surgery,Taizhou Hospital of Zhejiang Province,Taizhou 317000,China)
出处
《中国现代医生》
2020年第15期174-177,共4页
China Modern Doctor
基金
浙江省基础公益研究计划项目(LGF19H160017)。
关键词
结直肠癌
经自然腔道取标本
加速康复
NOSESⅣ型改良手术
无菌无瘤
Colorectal cancer
Natural orifice specimen extraction surgery
Enhanced recovery
NOSES typeⅣmodified surgery
Aseptic and tumor-free
