| BACKGROUND: Recent years,the incidence of colorectal cancer has increased year by year.The incidence of colon cancer ranks fourth in China,and the mortality rate ranks fifth.At present,the treatment of colon cancer is a multidisciplinary treatment based on surgery,radiotherapy and chemotherapy.In the 21 st century,with the in-depth development of minimally invasive techniques in various clinical disciplines,people are not only satisfied with the radical resection of oncology,but also have higher and higher aesthetic requirements for the appearance of the body.Natural orifice specimen extraction surgery(NOSES)came into being.NOSES mainly removes the specimen from the natural cavity of the human body(anal,vagina)and completes the reconstruction of the digestive tract.There are only a few trocar Scars in the abdomen after surgery.It is a more perfect description of the concept of minimally invasive,truly achieve the purpose of no auxiliary incision in the abdomen.Transvaginal specimen extraction for right-sided colon cancer is one of the classic NOSES surgery.As NOSES is accepted by more and more colorectal surgeons,NOSES technology is becoming more and more widely used at China and abroad.Studies have confirmed the feasibility and safety of NOSES.Therefore,it is necessary to conduct further clinical studies to evaluate the short-term efficacy of the NOSES procedure.OBJECTIVE: To investigate the short-term efficacy of transvaginal specimens for laparoscopic right colon cancer(NOSES).METHODS: Retrospective analysis of 90 cases of laparoscopic right colon cancer radical surgery performed continuously in the anorectal surgery of Huaihe Hospital of Henan University from June 2015 to December 2018.Thirty-two patients underwent complete laparoscopic anastomosis,transvaginal specimen removal(NOSES group),and 58 patients underwent conventional abdominal wall removal specimen surgery(LAP group).The general data of the patients were matched by the propensity score matching method 1:1.31 pairs of cases were successfully matched.and the intraoperative and postoperative data were analyzed.RERULTS: After PSM,the baseline data of the two groups were balanced between the two groups.A total of 62 patients in two groups were successfully operated without conversion,There were no significant differences in intraoperative blood loss,lymph node dissection,sputum tumor cell positive rate,bacterial culture positive rate,postoperative follow-up and postoperative pelvic floor function evaluation(P > 0.05)..Neither tumor cells nor bacteria were detected in the rinse solution at the start of the operation.Compared with the LAP group,the incidence of postoperative complications was lower in the NOSES group(6.4% vs.29.0%,P = 0.006),and the recovery time of gastrointestinal function was shorter(2.58±0.92 vs.3.42±0.92,P = 0.001),postoperative hospital stay was shorter(6.68 ± 1.47 vs.9.58 ± 2.22,P < 0.001),postoperative pain score was lower(postoperative day 1: 2.35 ± 1.52 vs.4.87 ± 1.50;postoperative 3 days: 1.81 ± 1.11 vs.4.00 ± 1.18;postoperative day 5: 1.45 ± 1.00 vs.2.97 ± 1.17;P < 0.001),additional analgesic drug use rate was lower(12.9% vs.61.3%,P < 0.001),patients were more satisfied with the appearance of the abdominal wall after surgery(100% vs.23.6%,P < 0.001).CONCLUSION: This study used PSM to remove confounding factors,retrospectively analyzed the short-term efficacy of transvaginal specimens for laparoscopic right colon cancer radical resection.The results showed that the laparoscopic right laparoscopic right colon cancer radical resection was satisfactory,ensuring sterility.At the same time,there is a clear advantage in reducing postoperative pain,shortening postoperative hospital stay,reducing the incidence of postoperative complications,and making the appearance of the abdominal wall more beautiful. |
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