| Objective:The clinical and pathological data of patients who underwent complete laparoscopic radical resection of colorectal cancer via natural orifice specimen extraction surgery(NOSES)and those who underwent conventional laparoscopic radical colorectal cancer were collected to compare the operative time,intraoperative bleeding,time to first defecation after surgery,time to first liquid food after surgery,pain score on the first day after surgery,postoperative sleep quality score,postoperative hospital stay,postoperative complications including anastomotic leak,intestinal obstruction,surgical incision infection,and postoperative anal function,etc.to investigate the safety,feasibility and clinical results of natural orifice specimen extraction surgery.Methods:From January 2014 to January 2021,colorectal cancer patients admitted to gastrointestinal surgery affiliated Hospital of Chengde Medical College were selected as study samples.A total of 120 cases met the study criteria.Complete laparoscopic radical resection of colorectal cancer via natural orifice specimen extraction surgery in 60 cases(experimental group),traditional laparoscopic radical resection of colorectal cancer in 60 cases(control group).The experimental group had no abdominal incision,and the specimen was removed through the anus of the natural cavity.In the control group,the specimen was taken out through a 5cm auxiliary incision in the upper abdomen.The clinical outcomes of complete laparoscopic radical resection of colorectal cancer via natural orifice specimen extraction surgery(NOSES)were investigated by retrospectively analyzing the basic preoperative conditions(gender,age,BMI,tumor distance from the anus),operative elapsed time,intraoperative bleeding,postoperative time to first defecation,postoperative time to first liquid food,postoperative pain score on the first day,postoperative sleep quality score,postoperative hospital stay,postoperative related complications(anastomotic leak,intestinal obstruction,incisional infection),surgical incisional infection,postoperative anal function,and oncological indicators(pathological staging,degree of differentiation,TNM stage,number of lymph nodes detected,circumferential incisional margin)in both groups.All patient data were analyzed using Excel to create a database,and SPSS 19.0 statistical software was applied to analyze the data.Measurement data are described in terms of mean±standard deviation(x±s);count data are described in terms of composition ratio(%).The operation index and postoperative index were tested and analyzed,and the postoperative complications were evaluated by chi-square test.Results:There was no statistically significant difference in basic clinical data,gender,age,and BMI between the two groups.In the experimental group,there were 29 males and 31 females in the experimental group.The average age was(61.04±10.14)years old,and the average BMI was(24.09±3.19Kg/m~2).The preoperative colonoscopy reported that the average distance between the tumor and the anal margin was(11.94±6.19cm).In the control group,there were 38 males and 22 females,with an average age of(59.58±10.98)years and an average BMI of(25.12±3.92Kg/m~2).The preoperative colonoscopy reported that the average distance between the tumor and the anal margin was(11.50±3.49cm).Among the related indexes of surgery,there was no difference in the statistical results of intraoperative blood loss,first defecation time after operation,first meal time after operation,and number of lymph node dissection(P>0.05).The comparison of the length of operation time and the length of postoperative hospital stay between the two groups was statistically significant(P<0.05).The operation time of the experimental group was longer than that of the control group,but the postoperative hospital stay of the experimental group was shorter than that of the control group.In the experimental group,the average postoperative hospitalization time was(11.55±3.79)days,the average operative time was(207.75±65.56 min),the average operative bleeding loss was(36.66±12.84),the average initial exhaust time was(3.96±2.65)days,the average postoperative feeding time was(4.23±2.56)days,and the average lymph nodes(11.88±3.57)were detected.In the control group,The average postoperative hospitalization time was(15.90±7.47)days,the average operative time was(163.75±46.46 min),the average operative bleeding loss was(36.00±16.28),the average initial exhaust time was(4.96±1.85)days,the average postoperative feeding time was(5.01±2.04)days,and the average intraoperative lymph nodes(12.25±3.56)were detected.The difference between sleep score and pain index is statistically significant(P<0.05).In terms of sleep quality and pain,the experimental group is better than the control group.The experimental group had sleep quality scores(6.26±1.16)and pain scores(2.95±0.79).The control group had sleep quality scores(11.38±1.35)and pain scores(5.76±1.06).There was no statistical difference in the statistical analysis of postoperative complications between the two groups(P>0.05).Among the 60 patients in the experimental group,there were 2 cases of anastomotic leakage,1 case of incision infection,and no postoperative intestinal obstruction.Among the 60 patients in the control group,4 had anastomotic leakage,1 had an incision infection,and 1had postoperative intestinal obstruction.There was no significant difference in postoperative anal function between the two groups(P>0.05).Among the60 postoperative patients in the experimental group,60 patients had good postoperative anal function(Williams criteria).According to Kirwan classification,57 cases were grade I,2 cases were grade II,1 case was grade III,0 cases were grade IV,and 0 cases were grade V.example.Among the 60patients in the control group,the postoperative anal function was good(Williams criteria).According to Kirwan classification,55 cases were grade I,4 cases were grade II,1 case was grade III,0 cases were grade IV,and 0cases were grade V.Among the 60 pathological samples in the experimental group,46 were ulcerative adenocarcinoma and 14 were mass adenocarcinoma.The average maximum tumor diameter was(4.24±1.71cm).According to the AJCC TNM staging,the number of stage I patients was 3(5.0%),the number of stage II patients was 33(55.0%),and the number of stage III patients was 24(40.0%).In the control group,among the 60 pathological samples,46 cases were ulcerative adenocarcinoma and14 cases were mass adenocarcinoma.The average maximum tumor diameter was(3.86±1.68cm).According to the AJCC TNM staging,the number of stage I patients was 5(8.3%),the number of stage II patients was 32(53.3%),and the number of stage III patients was 23(38.3%).Postoperative pathology in both groups showed no cases of positive cut margins.Conclusion:Complete laparoscopic radical resection of colorectal cancer via natural orifice specimen extraction surgery(NOSES)has the advantages of less trauma,quick recovery after surgery,and low pressure on the patient’s heart.It is worthy of promotion. |
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