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中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 210 -213. doi: 10.3877/cma.j.issn.1674-3946.2022.02.025

论著

ERAS理念下NOSES在左半结肠癌腹腔镜下根治术中的应用研究
黄玉宝1,(), 陈志玉1, 周雄1   
  1. 1. 516001 广东惠州,惠州市中心人民医院肛肠外科
  • 收稿日期:2021-01-05 出版日期:2022-04-26
  • 通信作者: 黄玉宝

Application of ERAS NOSES in laparoscopic radical resection of left semicolon colon cancer

Yubao Huang1,(), Zhiyu Chen1, Xiong Zhou1   

  1. 1. Anorectal Surgery, Huizhou Central People's Hospital, Huizhou Guangdong Province 516001, China
  • Received:2021-01-05 Published:2022-04-26
  • Corresponding author: Yubao Huang
  • Supported by:
    Guangdong Medical Research Fund Project 2020(A2020507)
引用本文:

黄玉宝, 陈志玉, 周雄. ERAS理念下NOSES在左半结肠癌腹腔镜下根治术中的应用研究[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(02): 210-213.

Yubao Huang, Zhiyu Chen, Xiong Zhou. Application of ERAS NOSES in laparoscopic radical resection of left semicolon colon cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(02): 210-213.

目的

探讨快速康复外科(ERAS)理念下经自然腔道取标本手术(NOSES)在左半结肠癌腹腔镜下根治术中的应用效果。

方法

回顾性分析2019年1月至2020年12月80例左半结肠癌患者的临床资料,按术式不同将患者分为常规组和NOSES组,每组40例,两组均在ERAS理念指导下行腹腔镜左半结肠癌根治术,NOSES组采用NOSES法取出标本,常规组经辅助切口取标本。选用SPSS 22.0软件处理数据,围术期指标行独立t检验,NRS疼痛评分行重复测量方差分析,术后并发症情况行χ2检验,P<0.05 表示差异有统计学意义。

结果

两组手术时间、术中出血量、淋巴结清扫个数及引流管拔除时间比较差异无统计学意义(P>0.05);NOSES组患者术后首次下床、排气、排便时间及术后住院时间均显著缩短(P<0.05)。时间与方法在NRS疼痛评分上不存在交互作用(P>0.05),时间与方法在NRS疼痛评分上主效应显著,NOSES组患者术后疼痛程度轻于常规组(P<0.05)。NOSES组患者术后总并发症发生率显著比常规组低(5.0% vs. 20.0%),差异有统计学意义(P<0.05)。

结论

ERAS与NOSES联合应用于左半结肠癌腹腔镜治疗中,两者优势互补,具有疼痛轻、并发症少及康复快等优势,值得临床推广应用。

Objective

To investigate the application of NOSES under ERAS concept in laparoscopic radical resection of left colorectal cancer.

Methods

The clinical data of 80 patients with left colon cancer from January 2019 to December 2020 were retrospectively analyzed. The patients were divided into the conventional group and the Diluted group respectively,40 cases in each group. Both groups underwent laparoscopic radical resection of left colon cancer under the guidance of ERAS concept. In the conventional group,specimens were collected through auxiliary incision. SPSS 22.0 software was used to process the data. Independent t-test was used for perioperative indicators,repeated measurement an OVA was used for NRS pain score,and χ2 test was performed for postoperative complications. P<0.05 indicated statistically significant differences.

Results

There were no significant differences in operative time,intraoperative blood loss,number of lymph node dissection and drainage tube removal time between the two groups(P>0.05). The first time out of bed,the time to exhaust,the time to defecate and the time to stay in hospital after the NOSES group were significantly reduced(P<0.05). There is no interaction between time and method on THE NRS pain score(P>0.05). The main effect of time and method on the NRS pain score is significant. The postoperative pain in the NOSES group is lighter than that in the conventional group(P<0.05). The incidence of postoperative complications in the NOSES group was significantly lower than that in the conventional group(5.0% vs. 20.0%),and the difference was statistically significant(P<0.05).

Conclusion

The combination of ERAS and NOSES in laparoscopic treatment of left colorectal cancer has the advantages of less pain,fewer complications and faster recovery,which is worthy of clinical application.

表1 80例左半结肠癌根治不同术式两组患者一般资料比较[(
xˉ
±s),例]
图1 左半结肠癌根治术NOSES关键操作步骤注:①经肛置入保护套;②打开保护套;③标本装入保护套;④切除远端肠管切口;⑤置入抵钉座;⑥切除闭合近端肠管切口;⑦吻合肠管;⑧经肛注气测漏。
表2 80例左半结肠癌根治不同术式两组患者围手术期指标比较[(
xˉ
±s),例]
表3 80例左半结肠癌根治不同术式两组患者术后疼痛程度评分(
xˉ±s
表4 80例左半结肠癌根治不同术式两组患者术后并发症发生情况[例(%)]
[1]
蒋汉卿,何进伟,罗水祥,等. 腹腔镜下结肠癌根治术与开腹结肠癌根治术近远期疗效的对比分析[J]. 肿瘤预防与治疗202033(3):248-252.
[2]
沈家生,唐成武. 腹腔镜结肠癌根治术近期疗效及安全性研究[J]. 中国现代医生201856(34):52-55.
[3]
李静,殷红专. 加速康复外科理念在结肠癌切除术后胃肠功能恢复中的临床效果[J]. 中国医药导报201916(4):169-172.
[4]
关旭. 结直肠肿瘤经自然腔道取标本手术专家共识(2019版)[J/CD]. 中华结直肠疾病电子杂志20198(4):336-342.
[5]
尹义学,蔡彬彬,司亮,等. 自然腔道取出标本手术对直肠癌患者术后康复及免疫功能的影响分析[J]. 中国普通外科杂志201928(4):392-398.
[6]
池风旭,朴大勋. 腹腔镜左半结肠癌根治术现状及进展[J]. 临床外科杂志201927(9):822-824.
[7]
Jacobs M,,Verdega JC,,Goldstein HS. Minimally invasive colonresection(laparoscopic colectomy)[J]. Surg Laparosc Endosc19911(3):144-155.
[8]
徐家明,王杰,刘佳文,等. 加速康复外科理念下经自然腔道取标本手术治疗结直肠癌围手术期疗效[J/CD]. 中华普外科手术学杂志(电子版)201913(1):29-32.
[9]
Pedziwiatr M,,Mavrikis J,,Witowski J,et al. Current status of enhanced recovery after surgery(ERAS)protocol in gastrointestinal surgery[J]. Med Oncol201835(6):95.
[10]
Nelson G,,Bakkum-Gamez J,,Kalogera E,et al. Guidelines for perioperative care in gynecologic/oncology:enhanced recovery after surgery(ERAS)society recommendations-2019 update[J]. Int J Gynecol Cancer201929(4):651-668.
[11]
Schneider S,,Armbrust R,,Spies C,et al. Prehabilitation programs and ERAS protocols in gynecological oncology:a comprehensive review[J]. Arch Gynecol Obstet2020301(2):315-326.
[12]
Shang Y,,Guo C,,Zhang D. Modified enhanced recovery after surgery protocols are beneficial for postoperative recovery for patients undergoing emergency surgery for obstructive colorectal cancer:A propensity score matching analysis[J]. Medicine(Baltimore)201897(39):e12348.
[13]
Guan X,,Liu Z,,Longo A,et al. International consensus on natural orifice specimen extraction surgery(NOSES)for colorectal cancer[J]. Gastroenterol Rep(Oxf)20197(1):24-31.
[14]
梁磊,刘远廷,贾纯亮,等. 联合两种微创术式治疗直肠癌的临床疗效研究[J/CD]. 中华普外科手术学杂志(电子版)201913(1):19-21.
[15]
徐福建,谢铭. 经自然腔道取标本在腹腔镜直肠癌根治术中的应用进展[J/CD]. 中华普外科手术学杂志(电子版)202115(1):107-110.
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