Application Of Natural Orifice Specimen Extraction Surgery(NOSES) In Patients With Rectal Cancer In Qinghai

Objective: By comparing with the relevant data of ordinary laparoscopic anterior rectal resection,whether NOSES in Qinghai area is safe,effective and feasible in the application of rectal cancer should be analyzed,to further provide reference for the wide application of NOSES,and make it clear whether NOSES can benefit the vast number of patients with rectal cancer in our province.Methods: Since only the Affiliated Hospital of Qinghai University performed NOSES surgery in Qinghai Province,this clinical study used a retrospective study to collect the relevant medical records of patients with rectal cancer who were treated in the Affiliated Hospital of Qinghai University from January 2016 to August 2019.The patients were divided into the experimental group(NOSES)and the control group(Dixon)according to the difference of the operation methods.By comparing the preoperative general data and operation-related data of the two groups,conclusions were drawn from postoperative complications,postoperative pathological data and conditions of patients half a year later after operation.Results: Forty-seven patients in the experimental group and sixty-six in the control group were collected.After statistical comparative analysis,there result showed no statistical difference in gender(p=0.849)、age(p=0.624)and BMI index(p=0.326),there have comparability.In the experimental group,the operation time was longer than traditional laparoscopic group(p≤0.001),the time of first exhaust(p=0.015)、 the time of first liquid inlet(p=0.004)、the time of first got out of bed(p=0.003)and surgery Post-hospitalization time(p=0.010)were earlier than that in the traditional laparoscopic group;the quantity of postoperative analgesics in the experimental group was less than what in the traditional laparoscopic group(p≤0.001),the amount of surgical bleeding(p=0.055)was less than that in the traditional laparoscopic group either.There was no statistical difference in Total cost of hospitalization(p=0.059),among all kinds of postoperative complications relevant,pulmonary infection(p=0.728)、intestinal obstruction(p=0.372)、intra-abdominal infection(p=0.168)and anastomotic leakage(p=0.436),intra-abdominal hemorrhage(p=0.372)、infection of incisional wound(p=0.138).There was no statistical difference in total number of lymph node dissection(p=0.425)、 the number of positive lymph node dissection(p=0.417)、TNM stage of tumor(p=0.623),Local recurrence,distant metastasis and Post operative anal function score(p=0.795)had no statistical difference.Conclusion: By comparing the clinical data of NOSES group and traditional laparoscopy group,the results showed that;1.there was no significant difference in the general condition between the two groups and it is comparable;2.There was no significant difference in operative blood loss,lymph node dissection,lymph node positive rate,postoperative complications and operation cost between them.There was no local recurrence and distant metastasis between the two groups half a year later after operation,and there was no significant difference in anal function score between the two groups.3.The operation time of experimental group was relatively longer,but the patients in NOSES group could get out of bed,do ventilation and have liquid diet earlier,and their use of postoperative painkillers was significantly reduced,and the postoperative hospital stay was relatively shorter.4.Master the indication of NOSES and operate it properly,NOSES will not increase the occurrence of postoperative complications(such as anastomotic leakage,abdominal infection or abdominal bleeding,etc.)and the risk of anal injury,will not increase the financial burden of patients,nor affect the prognosis of patients within six months.5.According to the statistical results of the current surgical cases,it can be seen that NOSES has the advantages of reducing postoperative pain,getting out of bed early and shortening the days of hospital stay.6.The application of NOSES in patients with rectal cancer in Qinghai is safe,effective and feasible,and it is a choice for patients with rectal cancer in our province.