| [Objective]The natural orifice specimen extraction surgery of colorectal cancer is one of the new technologies in the field of gastrointestinal surgery in recent years,but it is still in its infancy and there are some controversies such as opening the intestine in the abdominal cavity.There is still a lack of regulation to achieve better surgical aseptic effect and enough national data to reasonably predict the incidence of abdominal infectious complications and formulate corresponding strategies.According to the statistics of the Chinese Gastrointestinal Oncology Surgery Alliance,the main cause of secondary surgery and postoperative death is associated with abdominal infectious complications.Compare the incidence of postoperative abdominal infectious complications such as anastomotic leakage and other abdominal pelvic infections in patients with colorectal cancer undergoing natural orifice specimen extraction surgery and Clavien-Dindo classification and intraoperative peritoneal lavage fluid and postoperative abdominal drainage fluid bacterial positive rate and white blood cell count and neutrophil count and C-reactive protein level and procalcitonin and other inflammatory indicators and interventions and outcomes,then evaluate the aseptic effect of natural orifice specimen extraction surgery of colorectal cancer as one of the new technologies.Summarization of various operational details of the two kind of surgeries and perioperative preparation and etc can help to analyze strategies to improve the surgical sterility and the safety of surgery and reduce postoperative abdominal infections with the corresponding grading down and the standardized registration of surgical complications in the country of the natural orifice specimen extraction surgery,provide theoretical basis and clinical data support for the development of natural orifice specimen extraction surgery of colorectal cancer.[Methods]100 cases of colorectal malignant tumors from January 2018 to July 2019 in the general surgery department of Qingdao Municipal Hospital were prospectively collected.The patients were randomly divided into one group with natural orifice specimen extraction surgery and another group with regular laparoscopic surgery.In the natural orifice specimen extraction surgery group,40 cases of colorectal cancer were in,8 cases were excluded,32 cases were finally enrolled.60 eases of regular laparoscopic surgery group,11 cases were excluded,and 49 cases were finally enrolled.The ethics committee of the Qingdao Municipal Hospital approved the study,and the enrolled patients knew the general situation of the study and signed the informed consent form to express their consent to participate in the survcy.The main indicators included:the positive rate ofbacterial culture in the last intrapcritoncal lavage fluid during surgery and the positive rate of bacterial culture in the abdominal drainage solution on the 5th day after surgery,and the white blood cell count and neutrophil count and C-reactive protein and procalcitonin levels before surgery and 1 day and 3 days and 5 days after surgery,the incidence of postoperative abdominal in fection complications.Secondary observations included:gender,age,BMI,albumin,prealbumin levels,presence or absence of diabetes,intraoperative status(intraoperative blood loss,operative time,tumor stage),intraoperative and postoperative transfusion,hospitalization days,etc.In this study,the statistical software SPSS 24.0 was used to calculate and analyze the collected data.The statistical data were presented by mean with standard deviation,the measurement data were analyzed by t test,and the count data were analyzed by Fisher exact probability method.P<0.05 was considered statistically significant.[Results]There were no significant differences in gender,age,BMI,albumin,prealbumin levels,presence or absence of diabetes,tumor distribution,intraoperative blood loss,intraoperative and postoperative blood transfusion between the two groups(P>0.05).The length of hospital stay was 12.33±3.28 days in natural orifice specimen extraction surgery group less than 15.06±3.65 days in regular laparoscopic surgery group(P<0.05).The length of operation time in natural orifice specimen extraction surgery group was 237.28±47.32min more than 195.55±47.25min in regular laparoscopic surgery group(P<0.05).The positive rate of bacteria culture of final intraoperative peritoneal lavage fluid in natural orifice specimen extraction surgery group was 28.13%vs 22.45%in regular laparoscopic surgery group.The positive rate of bacterial culture in abdominal drainage 5 days after surgery was 12.50%in natural orifice specimen extraction surgery group vs 10.20%in regular laparoscopic surgery group(P>0.05).The white blood cell counts before and 1 day after surgery between natural orifice specimen extraction surgery group and regular laparoscopic surgery group were 6.44±1.64*109/L vs 5.82±1.63*109/L/L、10.96±1.59*109/L vs 11.22±1.91*109/L,with no significant difference(P>0.05).The neutrophil counts before and 1 day after surgery between natural orifice specimen extraction surgery group and regular laparoscopic surgery group were 4.22±0.67*109/L vs 4.20±0.64*109/L,8.35 ± 1.1 7*109/Lvs 8.50±1.43*109/L with no significant difference(P>0.05).The C-reactive protein level before and 1 day after surgery between natural orifice specimen extraction surgery group and regular laparoscopic surgery group were 4.76±1.37mg/L vs 5.09 ± 1.20mg/L,24.89 ± 7.60 mg/L vs 26.07±6.67mg/L with no significant difference(P>0.05).The white blood cell count,neutrophil count and C-reactive protein level on the 3rd day after operation between natural orifice specimen extraction surgery group and regular laparoscopic surgery group were 1 1.14±2.11*109/L vs 12.96±2.56*109/L,7.73±1.09*109/L vs 8.58±1.70*109/L,25.97±8.05mg/L vs 33.38±9.18mg/L with statistics differences(P<0.05).The white blood cell count,neutrophil count and C-reactive protein level on the 5th day after operation between natural orifice specimen extraction surgery group and regular laparoscopic surgery group were 8.19±2.30*109/L vs 9.96±2.79*109/L,5.41 ± 1.51*109/L vs 6.57±1.83*109/L、15.31±6.22mg/L vs 19.87±7.13mg/L with statistics differences(P<0.05).The level of procalcitonin before and 1st day and 3rd and 5th day day after surgery between natural orifice specimen extraction surgery group and regular laparoscopic surgery group were 0.29 ± 0.16ng/ml vs 0.28 ± 0.15ng/ml,0.31 ±0.13ng/ml vs 0.27±0.16ng/ml,0.28±0.13ng/ml vs 0.29±0.14ng/ml,0.40±0.43ng/ml vs 0.39±0.51ng/ml,with no significant difference(P>0.05).The incidence of intra-abdominal infectious complications between natural orifice specimen extraction surgery group and regular laparoscopic surgery group was 12.50%vs 10.20%with no significant difference(P>0.05)[Conclusion]The positive rate of bacteria culture of final intraoperative peritoneal lavage fluid and positive rate of bacterial culture in abdominal drainage 5 days after surgery were similar between natural orifice specimen extraction surgery group and regular laparoscopic surgery group.There was no significant difference in the incidence of postoperative abdominal infectious complications between two groups.However,natural orifice specimen extraction surgery group had less inflammatory response,faster recovery and a lower incidence of wound infection.Perioperative adequate bowel preparation and rational use of intraoperative polyvinylpyrrolidone iodine gauze and augmentation of the applicator and use of self-made specimen bags and improved nail placement may be beneficial to maintain or even optimize surgery aseptic effect and safety and etc.Combining with other studies on colorectal cancer about tumor-free effect and curative rate and patient satisfaction and ctc,this research suggests that it is possible to further promote natural orifice specimen extraction surgery under the premise of grasping the indications for surgery.However,a large number of multicenter clinical data are still needed to support this view. |
PDF Full Text Request