| Background: With the deepening of the concept of minimally invasive surgery and the development of enhanced recovery after surgery,more and more people pay attention to natural orifice specimen extraction surgery.NOSES is at the stage of development.The prognosis and complications of colorectal NOSES patients during limited follow-up period are not significantly different from those of traditional laparoscopic surgery,but they have obvious advantages in postoperative recovery,cosmetic effect and reducing the psychological burden of patients.It has high clinical research value.Two key points of NOSES for colorectal cancer are specimen extraction and digestive tract reconstruction.There are many ways to do this.Clinicians should choose the best plan according to the location,size and stage of patients’ tumors,which is also the key step to decide whether the operation could be successfully completed.In NOSES operation for colorectal cancer,the common method of specimen extraction was using TEM instrument or plastic protective sheath to assist the extraction of dismembered tumors through the anus.This method is suitable for patients whose mesentery not too thick and the location of tumor not too high,but for patients that low rectal cancer,hypertrophy of mesentery and larger tumor size,this method may not be able to remove the tumor out or lead to tumor ruption.Cracks cause contamination and can not be accurately judge for the distal margin.In the reconstruction of digestive tract,the traditional reconstruction methods are endoscopic purse suture and nail seat reverse penetration,but these two methods are difficult to operate under the endoscope,and the probability of anastomotic leakage after operation is higher.Objecrive: By summarizing and comparing the methods of specimen extraction and digestive tract reconstruction in NOSES operation for colorectal cancer,a simple and safe method of digestive tract reconstruction in NOSES operation for colorectal cancer and the method of specimen extraction for low rectal cancer were sought to provide reference for the future development of NOSES operation for colorectal cancer.Methods: Retrospective analysis of patients undergoing NOSES operation for colorectal cancer from August 2016 to December 2018 in the department of gastrointestinal surgery of the first Bethune Hospital of Jilin University: 1.63 patients with low rectal cancer undergoing NOSES operation were selected and divided into two groups according to specimen extraction method.Group A: two step procedure to turn rectum inside out from abdominal(39 cases)and Group B: traditional one step to turn rectum inside out from abdominal(24 cases).The maximum tumor diameter,success rate,grinding rate,operation time,amount of bleeding,postoperative first time to return of flatus,incidence of postoperative anastomotic leakage,short-term follow-up and other short-term efficacy indicators of the patients in two groups were compared.2.The study of digestive tract reconstruction in NOSES operation for colorectal cancer: 92 patients with NOSES operation for colorectal cancer were selected and divided into two groups according to digestive tract reconstruction methods: group A was adopted the method of improved reverse cabling tie anvil insertion(56 cases);group B was adopted traditional method of pursing string suture anvil(36 cases).The operation time,intraoperative bleeding and postoperative recovery were compared between the two groups(incidence of postoperative anastomotic leakage,postoperative first time to return of flatus,and postoperative hospital stay).Results: 1.Study on the method of specimen extraction: 63 patients were successfully completed surgery.The success rate of group A was higher than that of group B,the tumor grinding rate was lower than group B,the operation time was shorter than group B,and the difference has statistically significant(P < 0.05).There was no significant difference in the amount of bleeding during operation,the postoperative first time to return of flatus,the maximum diameter of tumors and incidence of postoperative anastomotic leakage between the two groups(P > 0.05).Following up for 3 to 24 months(median 10 months),there was no significant difference in recurrence rate and metastasis of carcinoma rate between two groups(P > 0.05).2.Study on digestive tract reconstruction in NOSES operation for colorectal cancer: 92 patients successfully completed abdominal operation without auxiliary incision and conversion to open surgery.There was no significant difference in the amount of bleeding during operation,postoperative first time to return of flatus and postoperative hospital stay between the two groups(P > 0.05).The operation time of group A was shorter than that of group B,and the incidence of postoperative anastomotic leakage was lower than that of group B.The difference has statistically significant(P < 0.05).Conclusion: 1.Compared with the traditional one step procedure to turn rectum inside out from abdominal cavity,the two step procedure to turn rectum inside out from abdominal cavity can reduce the difficulty of rectal inversion in NOSES of low rectal cancer,increase the success rate of inversion,shorten the operation time.It also can reduce the pressure of tumors in the process of inversion,reduce the fragmentation rate of tumors,reduce intraoperative contamination and the probability of tumor implantation,and increase the safety of operation.2.Complete colorectal cancer NOSES surgery by using the method of improved reversing cabling tie anvil insertion anastomosis has the advantages of simple and fast effect.At the same time,it improves the back-puncture method,reduces the incidence of postoperative anastomotic leakage after operation,and has more advantages than traditional method of pursing string suture anvil. |
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