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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (01) : 19 -21. doi: 10.3877/cma.j.issn.1674-3946.2019.01.008

所属专题： 文献；

论著

联合两种微创术式治疗直肠癌的临床疗效研究
梁磊1,†(), 刘远廷1, 贾纯亮1, 姚远1, 康恺1, 张磊1, 李翰嵩1   
  1. 1. 063000　河北省唐山市人民医院胃肠外科
  • 收稿日期:2018-06-30 出版日期:2019-02-26
  • 通信作者: 梁磊

Clinical study of combined minimally invasive surgical treatments for rectal cancer

Lei Liang1,†(), Yuanting Liu1, Chunliang Jia1, Yuan Yao1, Kai Kang1, Lei Zhang1, Hansong Li1   

  1. 1. Department of Gastrointestinal Surgery, Tangshan people’s hospital, HeBei, 063000 China
  • Received:2018-06-30 Published:2019-02-26
  • Corresponding author: Lei Liang
  • About author:
    Corresponding author: Liang Lei, Email:
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梁磊, 刘远廷, 贾纯亮, 姚远, 康恺, 张磊, 李翰嵩. 联合两种微创术式治疗直肠癌的临床疗效研究[J/OL]. 中华普外科手术学杂志(电子版), 2019, 13(01): 19-21.

Lei Liang, Yuanting Liu, Chunliang Jia, Yuan Yao, Kai Kang, Lei Zhang, Hansong Li. Clinical study of combined minimally invasive surgical treatments for rectal cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(01): 19-21.

目的

评估腹腔镜下直肠癌切除术(LCRs)后进行经自然腔道标本取出术(NOSE)的患者的成功率和影响因素。

方法

回顾性分析2016年4月至2018年4月76例直肠癌患者LCRs之后尝试进行NOSE的资料。肛门入路作为第一选择，当此入路失败时，女性患者可尝试经阴道入路。如果两种入路都失败，则判定该患者不适合接受NOSE，并通过腹壁切口取出。记录手术指征，切除位置，实施程序，切口部位，吸引方法，标本大小和NOSE失败病例。采用SPSS18.0软件对数据进行统计分析，NOSE成功与失败病例χ2检验；标本大小采用t检验。P<0.05差异有统计学意义。

结果

7例患者需要在手术切除时转为腹壁开放切口手术。在剩下的69例患者中，51例(73.9%)成功完成LCRs后的NOSE，18例(26.1%)失败。患者的标本经肛门和经阴道入路提取的数量分别是48例(94.1%)和3例(5.9%)。LCRs后，结肠病变严重和肿瘤体积大的男性患者NOSE成功率较低。经肛门和经阴道切除标本的平均大小分别为(3.6±3.2)和(5.6±1.5) cm，失败病例的平均肿瘤大小为(6.6±4.4) cm，(P<0.05)。

结论

直肠癌患者在腹腔镜下直肠癌切除术后行经自然腔道标本取出术效果更好，较轻微的病变和女性患者具有较高的成功率。

关键词: 直肠肿瘤, 腹腔镜检查, 自然腔道内镜手术
Objective

To investigate success rate and influential factors of laparoscopic colorectal resections (LCRs) followed by natural orifice specimen extraction (NOSE) in patients with rectal cancer.

Methods

From April 2016 to April 2018, retrospective analysis were performed in 76 patients with rectal cancer who received LCRs+ NOSE. We prefer to anal approach firstly, however if it fails, vaginal approach would be tried. If both approaches fail, the patient would be judged to be unsuitable for NOSE, then specimen would be removed through abdominal incision. Surgical indications, location of excision, procedure, incision site, method of aspiration, specimen size, and NOSE failure were recorded. Statistical analysis were performed by using SPSS18.0 software was used for statistical analysis of the data, and the chi-square test of the success and failure cases of NOSE was used to analyze the data. The size of specimens was examined by t-test. P<0.05 was statistically significant.

Results

7 cases of conversions to open abdominal incision occurred during operation. 51 (73.9%) patients, including 48(94.1%) cases of anal approach and 3 (5.9%) cases of vagina approach, received successful NOSE after LCRs, while 18 (26.1%) cases failed A lower success rate of NOSE occurred mainly in male patients with severe colon lesions and large tumor size. The mean size of removed specimens was (3.6±3.2) and (5.6±1.5) cm by using anal approach and vaginal approach respectively, and the mean tumor size of the failed cases was (6.6±4.4) cm (P<0.05).

Conclusion

Better prognosis could be achieved in patients with rectal cancer underwent laparoscopic resection + NOSE, while higher success rate could be achieved when milder lesions or in female patients.

Key words: Rectal neoplasms, Laparoscopy, Natural orifice endoscopic surgery
表1 69例直肠癌患者NOSE成功与失败病例基本信息比较[例(%)]
基本信息与病理结果 自然腔道取出标本 P值
成功(n＝51) 失败(n＝18)
年龄(±s，岁) 56.9±13.4 60.5±13.3 0.34
性别 ? ? ?
? 男 27(52.9) 15 (83.3) ?
? 女 24(47.0) 3(16.7) 0.02
病理结果 ? ? ?
? 恶性 47(92.1) 16(88.9) ?
? 良性 4(7.8) 2(11.1) 0.71
表2 69例NOSE成功与失败病例结肠/直肠病变情况比较[例(%)]
结直肠病变 例数 自然腔道取出标本 P值
成功 失败
结肠病变 33 18(54.5) 15(45.5) ?
直肠病变 30 29(96.7) 1(3.3) 0.005
结肠直肠病变 6 4(66.7) 2(33.3) ?
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