Clinical Comparison Of Transanal Natural Orifice Specimen Extraction And Traditional Laparoscopic Anterior Resection In Rectal Cancer

ObjectiveTo compare the clinical effect of natural orifice specimen extraction surgery(NOSES)and traditional laparoscopic low rectal anterior resection to explore whether NOSES surgery is safe and effective in the application of rectal cancer and whether it affects the function of the anal sphincter,for the wide promotion of NOSES to provide reference.Materials and MethodsUsing retrospective research methods,the clinical pathological data of patients with rectal cancer admitted to the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Chengdu Medical College from August 1,2015 to May 31,2017will be collected through the Donghua HIS Electronic Medical Record System.The patients were divided into the NOSES group and the traditional laparoscopic group by the different surgical methods.The patient’s general condition,preoperative complications,intraoperative blood loss,operative time,postoperative first intake,postoperative first ambulation,postoperative analgesic drug addition frequency,postoperative hospital stay,postoperative anal function score,Postoperative pathological data and follow-up in the first half of the year were the observation indexes.SPSS21.0 statistical software was used to analyze the data.The data of NOSES group and traditional laparoscopic group were compared.ResultsTwenty-one patients in the NOSES group and 53 in the traditional laparoscopic group were collected.After comparison,the two groups showed gender(X~2=1.304,p=0.289),age(t=-0.024,p=0.981),BMI index(t=0.418,p=0.677),preoperative hypertension,There was no statistical difference in diabetes,chronic obstructive pulmonary disease(COPD),and coronary heart disease(X~2=0.115,0.083,0.797,0.015;p=0.998,0.763,0.397,0.903);the NOSES group got out of bed The activity time was earlier than that in the traditional laparoscopic group(1.05±0.22 d vs 2.77±1.28 d,t=6.116,P<0.001);the number of postoperative analgesics in the NOSES group was less than that in the traditional laparoscopic group(0.10±0.30 Vs 0.68±1.09,t=2.414,p=0.018).In the NOSES group,the operation time(245.29±52.66 min vs.227.79±56.19min,t=-1.264,p=0.214)and the amount of surgical bleeding(30.95±25.13 ml vs.47.74±69.08 ml,t=1.53,p=0.13),The time of first feeding(32.76±10.41 h vs32.15±19.72 h,t=-0.173,p=0.863),the time of first exhaust(59.52±15.24 h vs.57.06±23.42 h,t=-0.45,p=0.657),surgery Post-hospitalization time(14.43±3.99 d vs14.42±3.07 d,t=-0.014,p=0.989),postoperative anastomotic leakage(X~2=0.356,p=0.618),postoperative abdominal hemorrhage(X~2=0.185,p=0.972)Postoperative anal function score(X~2=4.457,p=0.726),number of lymph node dissection(13.71±2.12vs 12.64±6.04,t=-1.128,p=0.263),tumor TNM stage(X~2=4.783,p=0.091 There was no statistical difference between local recurrence and distant metastasis(X~2=0.155,P=0.694).ConclusionBy contrast between the two groups,transanal specimen extraction surgery for radical resection of rectal cancer does not increase the incidence of postoperative abdominal infections,postoperative anastomotic leaks,and postoperative abdominal bleeding,nor does it increase the incidence of anal dysfunction.In the comparison of tumor outcomes,NOSES did not reduce the composite of local recurrence and distant metastasis in rectal cancer within six months after surgery.NOSES is less invasive and has the advantage of less postoperative pain and early out of bed activity.Therefore,NOSES for radical resection of rectal cancer is safe and effective,it is a surgical method worthy of promotion.