摘要
【目的】探讨经肛门自然腔道取标本(NOSES)对腹腔镜直肠癌根治术后腹腔冲洗液肿瘤细胞学及细菌培养结果的影响。【方法】前瞻性选择2020年5月至2022年1月本院收治的38例直肠癌患者,均行腹腔镜直肠癌根治术。根据随机数字表法并结合患者意愿分组,将其分为NOSES组(16例)和非NOSES组(22例)。比较两组患者术后腹腔冲洗液脱落肿瘤细胞、细菌培养结果。【结果】两组患者术中腹腔冲洗液可见间皮细胞、淋巴细胞,均未见脱落肿瘤细胞,阳性率均为零,两组比较差异无统计学意义(P>0.05)。NOSES组16例术中腹腔冲洗液细菌培养4例为阳性,阳性率为25.0%,其中大肠埃希菌3例,屎肠球菌1例,阳性病例中1例患者术后反复高热,CT提示盆腔脓肿,经抗感染、引流后痊愈。非NOSES组22例术中腹腔冲洗液细菌培养有5例为阳性,阳性率为22.7%,其中大肠埃希菌4例,肺炎克雷伯菌1例,未发生腹腔感染等。两组阳性率比较,差异无统计学意义(χ^(2)=0.026,P>0.05)。【结论】与传统腹腔镜直肠癌根治术相比,经肛门NOSES腹腔镜直肠癌根治术未明显增加手术肿瘤细胞种植播散及腹腔感染相关风险,符合无菌、无瘤原则。
【Objective】To investigate the effect of natural orifice specimen extraction surgery(NOSES)on the oncology and bacterial culture of peritoneal lavage fluid after laparoscopic radical resection of rectal cancer.【Methods】Thirty-eight patients with rectal cancer admitted to our hospital from May 2020 to January 2022 were prospectively selected for laparoscopic radical resection of rectal cancer.According to the random number table method and combined with the wishes of patients,they were divided into NOSES group(16 cases)and non NOSES group(22 cases).The results of tumor cells exfoliated from peritoneal lavage fluid and bacterial culture indicators were compared between the two groups.【Results】Mesothelial cells and lymphocytes were visible in the peritoneal lavage fluid of the two groups of patients during surgery,and no exfoliated tumor cells were found.The positive rate was 0 for both groups,with no statistically significant difference between the two groups(P>0.05).In the NOSES group,4 cases of the 16 cases in the intraoperative peritoneal lavage fluid bacterial culture medium were positive,with a positive rate of 25.0%,including 3 cases of Escherichia coli and 1 case of Enterococcus faecium.Among the positive cases,1 patient had recurrent high fever after surgery.CT showed that the pelvic abscess recovered after anti infection and drainage.In the non NOSES group,5 cases were positive in the bacterial culture medium of intraoperative peritoneal lavage fluid,with a positive rate of 22.7%,including 4 cases of Escherichia coli and 1 case of Klebsiella pneumoniae.There were no cases of abdominal infection.There was no statistically significant difference in the positive rates between the two groups(χ^(2)=0.026,P>0.05).【Conclusion】Compared with traditional laparoscopic radical resection of rectal cancer,transanal NOSES laparoscopic radical resection of rectal cancer does not significantly increase the risk of surgical tumor dissemination and abdominal infection,and conforms to the principle of aseptic and tumor free.
作者
王定平
鲁瑞林
陈焕新
王东
冯春保
WANG Ding-ping;LU Rui-lin;CHEN Huan-xin(Suining City First People's Hospital,Suining Sichuan 629000)
出处
《医学临床研究》
CAS
2023年第3期325-327,331,共4页
Journal of Clinical Research
基金
四川省医学青年创新科研课题计划(Q20026)。
