切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 65 -68. doi: 10.3877/cma.j.issn.1674-3946.2023.01.016

论著

NOSES-Ⅰ式B法与腹腔镜经括约肌间切除术在低位直肠癌中的对比研究
李文熙1, 郑鑫1, 孙宝信1, 张海生1, 朱志达1, 赵恩宏1,()   
  1. 1. 067000 河北承德,承德医学院附属医院胃肠外科
  • 收稿日期:2022-03-02 出版日期:2023-02-26
  • 通信作者: 赵恩宏

NOSES-Ⅰ B method versus laparoscopic intersphincter resection in low rectal cancer

Wenxi Li1, Xin Zheng1, Baoxin Sun1, Haisheng Zhang1, Zhida Zhu1, Enhong Zhao1,()   

  1. 1. Department of Stomach Enterochirurgia,The Affiliated Hospital of Chengde Medical College,Chende Heibei Province 067000,China
  • Received:2022-03-02 Published:2023-02-26
  • Corresponding author: Enhong Zhao
  • Supported by:
    Chengde Science and technology Research and Development Program(202006A085)
引用本文:

李文熙, 郑鑫, 孙宝信, 张海生, 朱志达, 赵恩宏. NOSES-Ⅰ式B法与腹腔镜经括约肌间切除术在低位直肠癌中的对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(01): 65-68.

Wenxi Li, Xin Zheng, Baoxin Sun, Haisheng Zhang, Zhida Zhu, Enhong Zhao. NOSES-Ⅰ B method versus laparoscopic intersphincter resection in low rectal cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(01): 65-68.

目的

对比研究经自然腔道取标本手术(NOSES)Ⅰ式B法与腹腔镜经括约肌间切除术(ISR)在低位直肠癌中的临床效果。

方法

前瞻性选取2017年6月至2021年6月确诊为低位直肠癌的患者100例,随机数字表法将其分为两组,每组各50例,NOSES组行NOSES-Ⅰ式B法,ISR组行ISR。比较两组患者围手术期指标、术后并发症及肛门直肠功能。采用统计学软件SPSS 20.0完成数据分析,术后并发症、Kirwan分级等计数资料组间比较行x2检验;围手术期指标、Wexner评分等计量资料用(

xˉ
±s)表示,组间比较行t检验。P<0.05为差异有统计学意义。

结果

NOSES组手术时间、首次排气时间、术后住院时间等指标均短于ISR组(P<0.05);两组术后并发症总发生率比较,差异无统计学意义(P>0.05);NOSES组患者术后6月、12月Wexner评分显著低于ISR组(P=0.000);NOSES组Kirwan分级情况优于ISR组(P=0.029)。

结论

低位直肠癌患者行NOSES-Ⅰ式B法治疗相比ISR术,手术时间短,术中出血少,可有效保护患者直肠肛门功能,更利于其术后恢复。

Objective

This study is a comparison of the clinical effect of the B-ⅰ method of natural NOSES versus laparoscopic intersphincter resection(ISR)in low rectal cancer.

Methods

A total of 100 patients diagnosed with low rectal cancer between June 2017 and June 2021 were prospectously assigned to two groups with 50 patients in each group using a random number table method. The NOSES group receives the Tnoses Ⅰ B method and the ISR group receives the ISR. Perioperative indexes,postoperative complications and anorectal function were compared between the two groups. Statistical software SPSS 20.0 was used to complete the data analysis,and the statistical data such as postoperative complications and Kirwan grading were compared between groups by x2 test. Measurement data such as perioperative indicators and Wexner score were represented by(

xˉ
±s). Comparison between groups was performed by t test. P<0.05 was considered statistically significant.

Results

NOSES group has shorter operating time,first exhaust time,and postoperative hospital stay than ISR group(P<0.05);There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05). The Wexner score of the NOSES group was significantly lower than that of the ISR group 6 months and 12 months after surgery(P=0.000);NOSES group Kirwan grading is superior to ISR group(P=0.029).

Conclusion

This NOSES Ⅰ type B therapy in patients with low rectal cancer has shorter operation time and less intraoperative bleeding than ISR,which effectively protects patients' rectal and anal function and is more beneficial to postoperative recovery.

表1 100例低位直肠癌保肛手术不同术式两组患者基线资料比较[(
xˉ
±s),例]
表2 100例低位直肠癌保肛手术不同术式两组患者围手术期指标比较(
xˉ
±s)
表3 100例低位直肠癌保肛手术不同术式两组患者并发症情况比较[例(%)]
表4 100例低位直肠癌保肛手术不同术式两组患者肛门功能比较[(
xˉ
±s),例]
[1]
刘宗超,李哲轩,张阳,等. 2020全球癌症统计报告解读[J/CD]. 肿瘤综合治疗电子杂志20217(02):1-13.
[2]
Wilkinson N. Management of Rectal Cancer[J]. Surg Clin North Am2020100(3):615-628.
[3]
韩俊毅,傅传刚. 低位直肠癌保肛手术方式及选择[J]. 结直肠肛门外科202026(01):5-10.
[4]
蒋鸿元,李亚平,朱明杰,等. 不同手术操作方式在直肠癌NOSES手术中的临床应用研究[J/CD]. 中华普外科手术学杂志(电子版),202014(04):350-353.
[5]
Chen JWChang WJZhang ZY,et al. Risk factors of anastomotic leakage after robotic surgery for low and mid rectal cancer[J]. Zhonghua Wei Chang Wai Ke Za Zhi202023(4):364-369.
[6]
王勇帮,黄忠诚,肖志刚,等. 慢传输型便秘合并成人巨结肠行结肠全切或次全切除及改良Duhamel吻合术对肛门功能的影响[J]. 中华胃肠外科杂志202124(12):1096-1099.
[7]
中国NOSES联盟,中国医师协会结直肠肿瘤专业委员会NOSES专委会. 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(04):336-342.
[8]
唐和春,刘东宁,朱伟权,等. 腹部无辅助切口经肛门外翻切除标本的机器人低位直肠癌根治术(NOSESⅠ式)一例报道[J/CD]. 中华结直肠疾病电子杂志20209(03):296-298.
[9]
Ding HLi JChen Y,et al. Anal function and quality of life analysis after laparoscopic modified Parks for ultra-low rectal cancer patients[J]. World J Surg Oncol202018(1):28.
[10]
磨鹏诗,杨平,陈应驹. 腹腔镜辅助TaTME术在低位直肠癌患者中的临床效果及安全性研究[J/CD]. 中华普外科手术学杂志(电子版),201913(02):155-158.
[11]
Yamada KSaiki YTakano s,et al. Long-term results of intersphincteric resection for low rectal cancer in Japan[J]. Surg Today201949(4):275-285.
[12]
Ito M. ISR for T1-2 Low Rectal Cancer:A Japanese Approach[J]. Clin Colon Rectal Surg202033(6):361-365.
[13]
亓军,周童,刘伟,等. 腹部无切口经肛门外翻切除的腹腔镜下低位直肠癌根治术的疗效分析[J]. 中国现代普通外科进展202023(07):515-517,522.
[14]
李兴旺,陈河金,李柄辉,等. 改良抵钉座体外置入法在经肛门外翻切除标本腹部无辅助切口腹腔镜低位直肠癌根治术中的应用[J]. 中华胃肠外科杂志201821(08):913-917.
[15]
胡军红,周世灿,张权,等. 抵钉座体外置入法经肛门外翻切除标本腹部无辅助切口腹腔镜低位直肠癌根治术的近期疗效[J]. 中国肿瘤外科杂志201911(01):21-25.
[16]
Yu SDeng JLuo T,et al. Study of anorectal dynamics in patients undergoing laparoscopic ultra-low resection and transanal intersphincteric resection for rectal cancer[J]. ANZ J Surg202090(12):2478-2483.
[1] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[2] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[3] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[4] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[5] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[6] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[7] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[8] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[9] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[10] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[11] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[12] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
阅读次数
全文


摘要