目的

探究腹腔镜经自然腔道手术（NOSES）对结直肠癌患者胃肠道功能和远期效果的影响。

方法

回顾性分析2019年6月至2022年6月102例结直肠癌患者的临床资料，依据手术方式不同分为常规组（n=62例）与NOSES组（n=40例），常规组行常规腹腔镜下结直肠癌根治术治疗；NOSES组行NOSES治疗。使用SPSS 22.0软件分析数据，计量资料以（）来表示，行独立样本t检验；计数资料以［例（%）］表示，行χ²检验；等级数据行秩和检验。检验标准为α=0.05。

结果

与常规组比较，NOSES组患者手术时间较长、术中失血量较少（P<0.05），术后排气时间及住院时间均明显缩短（P<0.05）。术后72h，与常规组比较，NOSES组患者血清C反应蛋白（CRP）、白细胞计数（WBC）和肿瘤坏死因子α（TNF-α）水平均较低（P<0.05），胃动素与胃泌素水平均较高（P<0.05）。两组患者术后并发症的总发生率、2年内肿瘤的远处转移率与局部复发率及患者生存率对比均无统计学差异（P>0.05）。

结论

NOSES用于治疗结直肠癌可有效改善围手术期指标，减轻患者机体炎症反应，促进其胃肠道功能的恢复，对其疾病远期复发和肿瘤转移无明显影响。

Objective

To explore the influence of laparoscopic natural orifice transluminal endoscopic surgery (NOSES) on the gastrointestinal function and long-term efficacy of patients with colorectal cancer.

Methods

The clinical data of 102 patients with colorectal cancer from June 2019 to June 2022 were retrospectively analyzed. According to different surgical methods, they were divided into the conventional group (n=62) and the NOSES group (n=40). The conventional group received conventional laparoscopic radical resection of colorectal cancer, and the NOSES group received NOSES treatment. The SPSS 22.0 software was used to analyze the data. Measurement data were expressed as (), and independent sample t tests were performed; Enumeration data were expressed as［ cases (%)］, and χ² tests were performed; Rank Sum tests were performed for ranked data. The test criterion was α=0.05.

Results

Compared with the conventional group,the patients in the NOSES group had a longer operation time and less intraoperative blood loss (P<0.05),and the postoperative exhaust time and hospital stay were significantly shortened (P<0.05). At 72 hours after the operation, compared with the conventional group, the levels of serum C-reactive protein (CRP), white blood cell count (WBC), and tumor necrosis factor-α (TNF-α) in the NOSES group were lower (P<0.05),and the levels of motilin and gastrin were higher (P<0.05). There were no statistically significant differences in the total incidence of postoperative complications, the distant metastasis rate and local recurrence rate of tumors within 2 years, and the survival rate of patients between the two groups (P>0.05).

Conclusion

NOSES used in the treatment of colorectal cancer can effectively improve the perioperative indexes, reduce the body's inflammatory response of patients, and promote the recovery of their gastrointestinal function. It has no obvious influence on the long-term recurrence of the disease and tumor metastasis.