摘要
目的:探讨反穿刺法放置吻合器抵钉座联合经自然腔道取标本手术(NOSES)在全腔镜直肠癌根治术中的应用价值。方法:回顾分析2017年3月至2020年2月为96例患者行腹腔镜直肠癌根治术的临床资料。患者均行Dixon术,其中观察组(n=45)采用反穿刺法联合NOSES行全腔镜直肠癌根治术,对照组(n=51)行腹腔镜辅助直肠癌根治术。观察两组手术时间、术中出血量、淋巴结清扫数量、术后第1天血红蛋白及白蛋白水平、术后24 h疼痛评分、术后肛门排气时间、术后住院时间、术后并发症发生率。结果:96例均顺利完成手术,观察组术后出现腹腔感染导致肠梗阻1例;对照组术后出现吻合口漏1例、吻合口出血1例、切口感染1例;积极治疗后患者均痊愈出院,无围手术期死亡病例。两组手术时间、术中出血量、淋巴结清扫数量、术后第1天血红蛋白及白蛋白水平、术后并发症发生率差异无统计学意义(P>0.05);观察组术后24 h疼痛评分、术后肛门排气时间、术后住院时间优于对照组(P<0.05)。结论:反穿刺法联合NOSES应用于全腔镜直肠癌根治术是安全的,手术效果良好,且更加微创,值得临床推广应用。
Objective:To investigate the application value of reverse puncture placement of stapler base combined with natural orifice specimen extraction surgery in total endoscopic radical resection of rectal cancer.Methods:The clinical data of 96 cases of laparoscopic radical resection of rectal cancer from Mar.2017 to Feb.2020 were retrospectively analyzed.All patients were treated with Dixon surgery,45 patients in the observation group were treated with reverse puncture combined with natural orifice specimen extraction surgery,and 51 patients in the control group were treated with laparoscopic-assisted radical resection.The operation time,intraoperative blood loss,number of lymph node dissection,hemoglobin and albumin levels in the first day after operation,postoperative 24 h pain score,postoperative anal exhaust time,postoperative hospital stay and incidence of postoperative complications in the two groups were observed.Results:All 96 operations were successfully completed,and one patient in the observation group developed abdominal infection leading to intestinal obstruction;in the control group,one patient developed anastomotic leak,one had anastomotic hemorrhage,and one had surgical incision infection,all of them recovered after active treatment without perioperative deaths.There were no significant differences between the two groups in operative time,intraoperative blood loss,number of lymph nodes dissected,hemoglobin and albumin levels on the first postoperative day,or incidence of postoperative complications(P>0.05).In the observation group,pain score was lower than that in the control group at 24 h after surgery,postoperative flatus was significantly earlier,and postoperative hospital stay was significantly shorter than that in the control group(P<0.05).Conclusions:The application of reverse puncture combined with natural orifice specimen extraction surgery in total endoscopic radical resection of rectal cancer is safe,effective and more minimally invasive,it is worthy of clinical popularization and application.
作者
汪明强
侯振宇
李昌安
李雪平
吕金利
WANG Ming-qiang;HOU Zhen-yu;LI Chang-an(Department of General Surgery,the 988th Hospital of the Joint Logistics Support Force of the People's Liberation Army,Zhengzhou 450007,China)
出处
《腹腔镜外科杂志》
2021年第8期595-599,共5页
Journal of Laparoscopic Surgery
关键词
直肠肿瘤
直肠癌根治术
腹腔镜检查
反穿刺
经自然腔道取标本手术
Rectal neoplasms
Radical resection of rectal cancer
Laparoscopy
Reverse puncture
Natural orifice specimen extraction surgery
