NOTES腹腔鏡下直腸癌根治術治療直腸癌的效果

王輝 劉愛芬

摘要：目的 ?探討經自然腔道內鏡手術（NOTES）治療直腸癌的效果。方法 ?選取2018年1月～2020年6月我院經手術治療的100例低位直腸癌患者作為研究對象，根據不同手術方法分為對照組54例和NOTES組46例。對照組采用傳統腹腔鏡低位直腸癌手術治療，NOTES組采用NOTES手術治療，比較兩組手術時間、手術出血量、近切緣距腫瘤上緣距離、遠切緣距腫瘤下緣距離、清掃淋巴結數目、術后3個月生存質量、手術并發癥發生情況。結果 ?兩組手術時間、近切緣距腫瘤上緣距離、遠切緣距腫瘤下緣距離、清掃淋巴結數目比較，差異無統計學意義（P>0.05）;NOTES組手術出血量低于對照組，差異有統計學意義（P<0.05）;NOTES組手術并發癥發生率為15.22%，與對照組的27.78%比較，差異無統計學意義（P>0.05）;術后3個月，NOTES組軀體功能、角色功能、軀體疼痛、整體健康狀況評分高于對照組，差異有統計學意義（P<0.05）;兩組情緒功能、認知功能、社會功能、精力評分比較，差異無統計學意義（P>0.05）。結論 ?NOTES治療直腸癌的效果與傳統腹腔鏡手術效果相當，但出血量更少，術后患者的生存質量更好。

關鍵詞：經自然腔道內鏡手術;直腸癌;生存質量

中圖分類號：R735.3 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2020.17.027

文章編號：1006-1959（2020）17-0095-03

Abstract：Objective ?To investigate the effect of natural endoscopic surgery （NOTES） in the treatment of rectal cancer.Methods ?A total of 100 patients with low rectal cancer who had undergone surgery in our hospital from January 2018 to June 2020 were selected as the research objects. According to different surgical methods， they were divided into control group 54 cases and NOTES group 46 cases. The control group was treated with traditional laparoscopic low rectal cancer surgery， and the NOTES group was treated with NOTES surgery. The operation time， surgical blood loss， distance between the proximal resection edge and the upper edge of the tumor， the distance between the far resection edge and the lower edge of the tumor， and the number of lymph nodes were compared between the two groups， 3 months after the operation， quality of life， surgical complications. Results ?There was no significant difference in the operation time， the distance between the proximal resection margin and the upper edge of the tumor， the distance between the distal resection margin and the lower edge of the tumor， and the number of lymph nodes dissected between the two groups （P>0.05）; the surgical blood loss in the NOTES group was lower than that in the control group，there was statistical significance （P<0.05）; the incidence of surgical complications in the NOTES group was 15.22%， compared with 27.78% in the control group， the difference was not statistically significant （P>0.05）;3 months after surgery， the scores of physical function， role function， physical pain， and overall health in the NOTES group were higher than those of the control group，the difference was statistically significant （P<0.05）; the two groups emotional function， cognitive function， social function， energy score comparison showed no statistically significant difference （P>0.05）.Conclusion ?The effect of NOTES in the treatment of rectal cancer was comparable to that of traditional laparoscopic surgery， but with less bleeding and better quality of life for patients after surgery.

Key words：Natural endoscopic surgery;Rectal cancer;Quality of life

直腸癌（colorectal cancer）屬于臨床常見的消化系統惡性腫瘤之一，近年來發病率呈現升高趨勢，目前手術根治是其首要方法，但手術過程中會給患者帶來機體創傷，使得應激反應增強、免疫功能下降，因此如何減輕患者應激反應和創傷具有重要意義[1]。近年來隨著微創理念的飛速發展，外科技術也帶來了較大的革新，經自然腔道內鏡手術（natural orifice transluminal endoscopic surgery，NOTES）已成為發展趨勢，其利用自然腔道可減少手術切口，更加符合現代外科理念，既可以最大程度將病變組織切除，同時還可以最大限度保留患者組織器官功能，但是在手術難度仍較大[2]。本研……