The safety and advantages of using threaded anal reamer in natural cavity sampling operation for ultra-low rectal cancer

doi:10.3877/cma.j.issn.1674-3946.2022.01.011

Abstract

Abstract:

Objective

To investigate the safety and advantages of screw-thread anal dilator in the treatment of ultra-low rectal cancer in natural orifice specimen extraction surgery（NOSES）.

Methods

The clinical data of 70 patients undergoing surgery for ultra-low rectal cancer from May 2017 to August 2019 were retrospectively analyzed. The patients were divided into two groups according to different surgical methods：Bacon group underwent improved Bacon method of sampling through natural cavity，and the anal dilator group underwent threaded anal dilator to complete the natural cavity，with 35 cases in each group.SPSS23.0 was used for statistical analysis. Perioperative indexes，anal function score（Wexner，Vaizey score）and other measurement data were expressed as（

x ˉ

±s），and independent t test was used. Postoperative complications were analyzed by χ² test. P<0.05 indicated statistically significant difference.

Results

The operation time of the Bacon group was significantly lower than that of the anal dilator group（P<0.05），while the intraoperative blood loss，first exhaust time and hospital stay of the anal dilator group were better than those of the improved Bacon group.（P<0.05）.There was no significant difference in the number of lymph node dissection between the two groups（P>0.05）. At 6and 12 months after surgery，Wexner score and Vaizey score were decreased，anal function gradually recovered，and the scores of the anal expander group were significantly lower than that of Bacon group（P<0.05）.The incidence of postoperative complications in the anal reamer group was significantly lower than that in the modified Bacon group（5.7% vs. 22.9%，P<0.05）.By September 2020，all patients were followed up，with an average follow-up time of（15.2 ± 2.8）months. No tumor recurrence or metastasis occurred in both groups.

Conclusion

The application of threaded anal reamer in the natural cavity for the operation of ultra-low rectal cancer can significantly reduce the occurrence of complications，reduce the amount of intraoperative blood loss，preserve the anal sphincter of patients and improve the postoperative anal function.

Key words: Rectal neoplasms, Screw-thread anal dilator, Natural orifice specimen extraction surgery, Safety

Mingjin Li, Zhaohui Wang, Jinzhou He. The safety and advantages of using threaded anal reamer in natural cavity sampling operation for ultra-low rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(01): 32-35.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2022.01.011

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2022/V16/I01/32

Figures/Tables 4

References 15

[1]	Paty PB,，Cercek A,，Crane CH. Reducing the morbidity of rectal cancer treatment［J］. JAMA Oncol，2019，5（7）：940-941.
[2]	谢爽，张春旭，尹智渊，等. 改良腹腔镜肛提肌外腹会阴联合切除术治疗超低位直肠癌的近期疗效［J］. 中华消化外科杂志，2020，19（10）：1091-1097.
[3]	Li Q,，Li D,，Jiang L，et al. Factors Influencing Difficulty of Laparoscopic Abdominoperineal Resection for Ultra-Low Rectal Cancer［J］. Surg Laparosc Endosc Percutan Tech，2017，27（2）：104-109.
[4]	Yu S,，Deng J,，Luo T，et al. Study of anorectal dynamics in patients undergoing laparoscopic ultra-low resection and transanal intersphincteric resection for rectal cancer［J］. ANZ J Surg，2020，90（12）：2478-2483.
[5]	Lu Z,，Chen H,，Zhang M，et al. Safety and survival outcomes of transanal natural orifice specimen extraction using prolapsing technique for patients with middle- to low-rectal cancer［J］. Chin J Cancer Res，2020，32（5）：654-664.
[6]	刘李，杨烈，杨柳，等. 腹腔镜下改良Bacon’s直肠癌根治术对患者术后肛门功能与远期疗效观察［J/CD］. 中华普外科手术学杂志（电子版），2020，14（1）：46-49.
[7]	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），2020，14（4）：350-353.
[8]	Bjoern MX,，Nielsen S,，Perdawood SK. Quality of Life After Surgery for Rectal Cancer：a Comparison of Functional Outcomes After Transanal and Laparoscopic Approaches［J］. J Gastrointest Surg，2019，23（8）：1623-1630.
[9]	王清奎，吉丙阳. 腹腔镜经肛拖出根治术与传统开腹切除术治疗中低位直肠癌的临床比较［J/CD］. 中华普外科手术学杂志（电子版），2019，13（4）：396-399.
[10]	Jayne D,，Pigazzi A,，Marshall H，et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal Cancer：the ROLARR Randomized Clinical Trial［J］. JAMA，2017，318（16）：1569-1580.
[11]	Peng B,，Lu J,，Wu Z，et al. Intersphincteric Resection Versus Abdominoperineal Resection for Low Rectal Cancer：A Meta-Analysis［J］. Surg Innov，2020，27（4）：392-401.
[12]	Paty PB,，Cercek A,，Crane CH. Reducing the morbidity of rectal cancer treatment［J］. JAMA Oncol，2019，5（7）：940-941.
[13]	2017 European Society of Coloproctology（ESCP）collaborating group. An international multicentre prospective audit of elective rectal cancer surgery；operative approach versus outcome，including transanal total mesorectal excision（TaTME）［J］. Colorectal Dis，2018，20（suppl 6）：33-46.
[14]	江波，卢艳军，刘海义，等. 经自然腔道取标本改良Bacon术在低位直肠癌中的应用［J］. 腹腔镜外科杂志，2018，23（11）：827-830.
[15]	庄成乐，张现中，刘骞，等. 基于一种螺纹扩肛器的超低位直肠癌精准保肛（PPS）手术［J/CD］. 中华结直肠疾病电子杂志，2019，8（5）：509-512.

组别	例	年龄（岁）	性别	BMI（kg/m²）	肿瘤距肛缘距离(cm)	肿瘤平均直径(cm)	TNM分期
组别	例	年龄（岁）	男/女	BMI（kg/m²）	肿瘤距肛缘距离(cm)	肿瘤平均直径(cm)	T1/T2/T3
Bacon组	35	62.8±9.4	16/19	25.1±2.6	3.7±1.2	2.9±0.7	16/15/4
扩肛器组	35	64.1±9.8	18/17	25.8±2.9	3.6±1.5	3.1±0.8	17/16/2
t/χ²		0.566	0.229	1.063	0.308	1.113	0.729
P		0.287	0.632	0.146	0.379	0.135	0.694

组别	例	年龄（岁）	性别	BMI（kg/m²）	肿瘤距肛缘距离(cm)	肿瘤平均直径(cm)	TNM分期
组别	例	年龄（岁）	男/女	BMI（kg/m²）	肿瘤距肛缘距离(cm)	肿瘤平均直径(cm)	T1/T2/T3
Bacon组	35	62.8±9.4	16/19	25.1±2.6	3.7±1.2	2.9±0.7	16/15/4
扩肛器组	35	64.1±9.8	18/17	25.8±2.9	3.6±1.5	3.1±0.8	17/16/2
t/χ²		0.566	0.229	1.063	0.308	1.113	0.729
P		0.287	0.632	0.146	0.379	0.135	0.694

组别	例	手术时间（min）	术中出血量（ml）
Bacon组	35	158.3±22.1	83.0±12.2
扩肛器组	35	169.4±20.5	76.5±14.8
t		2.178	2.005
P		<0.05	<0.05
组别	例	术后首次排气时间(d)	住院时间(d)
Bacon组	35	1.4±0.4	6.9±1.8
扩肛器组	35	1.2±0.3	6.1±1.3
t		2.646	2.132
P		<0.05	<0.05

组别	例	手术时间（min）	术中出血量（ml）
Bacon组	35	158.3±22.1	83.0±12.2
扩肛器组	35	169.4±20.5	76.5±14.8
t		2.178	2.005
P		<0.05	<0.05
组别	例	术后首次排气时间(d)	住院时间(d)
Bacon组	35	1.4±0.4	6.9±1.8
扩肛器组	35	1.2±0.3	6.1±1.3
t		2.646	2.132
P		<0.05	<0.05

组别	例	时间	Wexner评分	Vaizey评分
Bacon组	35	术后3个月	5.2±2.1	4.9±1.7
		术后6个月	2.6±1.0	2.2±1.1
		术后12个月	0.9±0.5	0.7±0.6
扩肛器组	35	术后3个月	4.7±1.8	4.5±1.5
		术后6个月	1.9±0.7^a	1.5±0.8^a
		术后12个月	0.6±0.3^a	0.4±0.1^a

Please choose a citation manager

Content to export