Analysis On Laparoscopic-assisted Natural Orifice Specimen Extraction Rectal Valgus Pull-out Surgery

Objective Analyze the safety,feasibility,and clinical efficacy of Laparoscopic-assisted natural orifice specimen extraction rectal Valgus pull-out Surgery.Methods A retrospective study was conducted on 7 patients with rectal cancer admitted in our hospital’s gastrointestinal surgery.Seven patients were divided into ultra-low rectal cancer group and low rectal cancer group according to tumor location.Both groups used LA-NOSE rectal valgus prolapse and the specific surgical procedures were slightly different.All operations were led by the same chief physician and lower-level physicians,the enrollment time was from June 2018 to April2020,including 3 males and 4 females,average age 60.9 ± 5.6 years,average BMI: 25.5 ± 3.3,average tumor maximum horizontal Diameter: 3.3± 0.3cm,average distance from the lower edge of the tumor to the anal margin: 5.4 ± 1.23 cm,all patients were diagnosed with rectal cancer by preoperative colonoscopy and pathological biopsy.: 2 cases of high-grade intraepithelial neoplasia,5 cases of rectal adenocarcinoma.Observe the operation time,estimated intraoperative blood loss,postoperative pathological type,negative rate of peripheral margin,lymph node dissection,exhaust time,postoperative hospital stay,postoperative complications,postoperative follow-up,etc.to evaluate the clinical efficacy and feasibility.Result All 7 patients successfully completed the LA-NOSE rectal valgus pull-out surgery.The average operation time was(350.7 ± 82.3)min,the estimated intraoperative bleeding was(58.6 ± 29.7)m L,and the average postoperative exhaust time was(48 ± 13.9)h.Average postoperative hospital stay(13.8 + 5.2)d((12 ± 1.9)d exclude 1 case of anastomotic fistula after surgery).Postoperative pathological report of 6 cases was moderately differentiated adenocarcinoma,and 1 case villous tubular adenoma and partial mucinous adenocarcinoma.Two patients had intestinal lymph node metastasis,and the remaining patients had no regional lymph node metastasis.Mesenteric lymph nodes were detected on average(15.3± 5.3).The upper and lower margins of all specimens were negative,and the average maximum transverse diameter of the tumor was(3.3 ± 0.6)cm.There were no deaths in the whole group,and one case of anastomotic leakage was cured after conservative treatment.There were no complications such as anastomotic leakage,anastomotic bleeding,and intestinal obstruction.Followed up for 6 to 22 months,most patients experienced frequent bowel movements within 1 month after operation.After functional exercise and conservative treatment,they can gradually restore their basic regular and normal bowel movements.After 3 months,they passed the kirwan anal function assessment,all patients were KirwanⅠtoⅡgrade,no stool incontinence,local recurrence and distant metastasis.Conclusion Laparoscopic-assisted rectal Valgus drag-out Surgery is safe,feasible,and has good clinical efficacy,which greatly improves the quality of life of patients after surgery.However,anal preserving surgery should still be performed on the premise of ensuring radicalness.If blindly choosing anal preserving cannot guarantee the radical resection of the tumor,the clinical efficacy cannot be discussed.Analysis of the long-term efficacy and postoperative survival rate of this surgical method requires more cases to accumulate and longer-term follow-up observation.