| Objective To compare the postoperative outcomes of NOSES(NOSES:Natural orifice specimen extraction surgery)in rectal tumors with conventional laparoscopic assisted radical resection of rectal cancer.The main aspects of this study included short-term clinical outcomes,nutritional status,and postoperative outcomes in the two groups.Stress levels and immune function.Methods A total of 62 patients with low rectal cancer admitted to the Department of General Surgery,Qingdao Municipal Hospital of 2016.9-2018.12 were enrolled.According to the surgical procedure,20 patients in the NOSES group and 42 patients in the laparoscopic group were included.Finally,16 patients in the NOSES group and 30 patients with LAP were enrolled in this comparative trial,a total of 46 patients.The postoperative venting time,the 3-day postoperative infection rate,the first day postoperative pain score(VAS method:Visual Analogue Scale),the length of hospital stay,and the hospitalization cost were recorded to compare the short-term clinical outcomes of the patients.The two groups were recorded 1 day before surgery.Plasma prealbumin and retinol-binding protein were compared on the 1st,3rd,and 7th postoperative days to compare the nutritional status of the patients.The IL-6,CRP,and Tnf-were recorded 1 day before surgery and 1,3,and 7 days after surgery.? was used to compare the patient's stress level;CD4+T,CD4+T/CD8+T were recorded on the 1st day before surgery and 1,3,and 7 days after surgery to compare the cellular immune function of the patients.Results The short-term clinical outcomes of the two groups were compared.The postoperative venting time of the NOSES group and the LAP group was 75.28±6.83 h vs81.75±8.69 h,respectively.The difference was statistically significant.The infection rate of the NOSES group and the LAP group was 3 days 25.0% vs 26.7%,the difference was not statistically significant;the first day postoperative VAS score of NOSES group and LAP group was 2.7±0.8 points and 3.9±1.4 points,respectively,the difference was statistically significant;NOSES group and The hospitalization time in the LAP group was8.31±1.55 days vs.9.53±1.89 days,the difference was statistically significant.The hospitalization expenses of the NOSES group and the LAP group were 65.04±4.36 thousand to 58.19±5.38 thousand,respectively,and the difference was statistically significant.The nutritional status of the two groups was compared.The plasma prealbumin and retinol binding protein in the NOSES group and the LAP group were179.48±22.59mg/L,170.37±18.34mg/L and 34.36±5.63mg/L,respectively.The difference was not statistically significant compared with 33.75±4.19mg/L.The plasmaprealbumin and retinol binding protein in NOSES group and LAP group were134.74±15.16mg/L and 133.93±14.36mg/L,respectively.The difference of25.69±4.57mg/L was 23.68±3.79mg/L.The difference was not statistically significant.The plasma prealbumin and retinol binding protein of NOSES group and LAP group were164.21±10.78mg/L on the 3rd day after operation.The difference was statistically significant than the ratio of 153.73±14.69mg/L and 29.69±4.81mg/L to 26.89±3.36mg/L.The plasma prealbumin and retinol binding protein in the NOSES group and LAP group on the 7th day after operation.The difference was 174.82±16.31 to 161.84±17.44mg/L and 35.57±5.31mg/L to 29.42±5.12mg/L,the difference was statistically significant.Compared with the immune function of the two groups,the CD4+T of the patients in the NOSES group and the LAP group was 43.56±3.63% vs.42.29±3.53%,respectively.The difference was not statistically significant.One day after surgery in the NOSES group and the LAP group.CD4+T was 33.72±2.94% vs 31.87±3.31%,respectively,and the difference was not statistically significant.On the third day after operation,the CD4+T levels were 35.89±3.83% vs 33.13±3.36%,respectively,which was significantly higher than that before surgery.The level of CD4+T in the LAP group was significantly lower than that in the NOSES group.The difference was statistically significant.The CD4+T/CD8+T levels in the NOSES group and the LAP group were 1.72±0.16 vs1.75±0.22,respectively.The difference was not statistically significant.The levels of CD4+T/CD8+T in the NOSES group and the LAP group were 1.46±0.22 vs 1.35±0.23,respectively,and the difference was not statistically significant.The patients in the NOSES group and the LAP group were 3 days after surgery.The CD4+T/CD8+T levels were 1.79±0.27 vs.1.52±0.26,respectively,and the difference was statistically significant.The CD4+T/CD8+T levels in the NOSES group and the LAP group were 1.89±0.15 vs1.66±7 days after surgery.0.28,the difference was statistically significant.The stress levels of the two groups were compared.The CRP levels in the NOSES group and the LAP group were 4.47±1.81 mg/L,4.35±1.62 mg/L,respectively.There was no statistically significant difference.The patients in the NOSES group and the LAP group underwent surgery.The levels of IL-6 in the first day were 93.14±21.57 ng/L vs.93.09±17.25 ng/L,respectively.There was no statistically significant difference.The Tnf-? levels in the NOSES group and the LAP group were 11.76±2.41fmol/day before surgery.There was no significant difference in L ratio from 11.51±1.96fmol/L.The CRP levels in patients with NOSES and LAP were 67.24±16.27mg/L and 69.26±16.71mg/L,respectively.There was no statistical difference.NOSES The IL-6 levels in the group and the LAP group were 120.73±19.06ng/L and 122.25±27.17ng/L,respectively.There was no statistical difference.The NOSES group and the LAP group had Tnf-? levels 1 day after operation.There was no statistically significant difference between14.91±1.97fmol/L and 16.19±2.39fmol/L.The CRP levels in the NOSES group and theLAP group were 125.31±16.67mg/L and 137.25±15.65mg/L,respectively.Statistical differences;IL-6 levels in the NOSES group and the LAP group were 124.54±19.98 ng/L to 136.32±15.45 ng/L,respectively,and there were statistical differences;patients in the NOSES group and the LAP group The 3-day Tnf-? level was 13.76±2.58fmol/L to15.25±2.19fmol/L,respectively.There was a statistical difference.The 7-day CRP level in the NOSES group and the LAP group was 41.03±18.27mg/L vs.68.45±.There was statistical difference in 12.65mg/L.The IL-6 levels in the NOSES group and the LAP group were 64.18±13.76ng/L and 76.92±16.18ng/L,respectively.There were statistical differences.The NOSES group and the LAP group The Tnf-? levels of patients at the 7th day after surgery were 11.17±2.15fmol/L to 13.34±1.72fmol/L,respectively,and there were statistical differences.Conclusion Compared with traditional laparoscopic assisted rectal cancer radical resection,the minimally invasive effect of rectal cancer NOSES is mild,and the postoperative pain is light.It can obtain better clinical outcomes and facilitate early recovery.It is worthy of clinical promotion and application. |
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