| Objective:Through retrospective analysis and study of the clinical data of two surgical methods of NOSES-Ⅰ type E method and laparoscopic low anterior resection in the treatment of patients with low rectal cancer,the efficacy of the two surgical methods in the treatment of ultra-low rectal cancer was compared.Safety and health economics and other indicators.Methods:Selected and collected 62 cases of ultra-low rectal cancer patients who were treated in the Colorectal and Anal Surgery Department of Shanxi Provincial Cancer Hospital from August June 2018 to February 2020,and divided them into groups A and B.Among them,patients in group A passed through the natural cavity.Specimen collection combined with modified Bacon surgery(NOSES-Ⅰ formula E method)was used for treatment,and patients in group B were treated by laparoscopic low anterior resection(LAR).Collect his medical records and conduct regular outpatient review,online questionnaire and telephone follow-up.Inclusion criteria of patients:(1)the lower boundary of the patient’s tumor was≤5cm from the anal margin;(2)the patient’s body mass index(BMI)<30kg/m2;(3)the patient’s preoperative anal sphincter function was normal and there was no stenosis;(4)the patient was preoperative No distant metastasis;(5)The preoperative MRI stage of the patient was T1～3N0～2M0.Exclusion criteria:(1)the patient was accompanied by intestinal obstruction and intestinal perforation before the operation;(2)the patient was over 85 years old;(3)the patient was unconscious or accompanied by mental illness;(4)the patient was accompanied by severe breathing And circulatory system disease history;(5)the patient’s tumor is too large to be dragged out of the anus;(6)the patient has distant metastases in the preoperative examination;(7)the patient who refused to follow-up during the follow-up.Statistics and comparison of the two groups of patients:(1)operation time;(2)intraoperative blood loss;(3)number of lymph nodes dissected;(4)the distance from the inferior margin of the tumor to the distal;(5)postoperative exhaust time;(6)postoperative time to eat and drink;(7)postoperative(8)Hospitalization time;(9)Hospitalization expenditure;(10)Preventive ileostomy;(11)Anastomotic leakage;(12)VAS pain score on the first day after operation;(13)Statistical analysis of differences in anal function at 6 and 12 months after surgery And conduct comparative analysis.Intraoperative and postoperative indicators used independent sample t-test or rank sum test,postoperative anal function and the incidence of complications were calculated usingX~2 test or Fisher’s exact probability.Results:There was no statistical difference between the two groups in general data such as age,gender,BMI,preoperative TNM staging,and tumor size(P>0.05).Both groups of patients successfully completed the operation.One patient in group B had an anastomotic leakage after surgery,and all patients in group B underwent preventive ileostomy during the operation.The operation time of the patients in group A was(228.2±66.1)min,and the operation time of patients in group B was(205.6±50.8)min,there was no significant difference between the two groups(P>0.05).The intraoperative blood loss in group A was(72.58±57.04)ml,intraoperative blood loss in group B was(77.74±61.63)ml,there was no significant difference between the two groups(P>0.05).The distance from the inferior margin of the tumor to the distal in group A was(2.13±0.13)cm,the distance from the inferior margin of the tumor to the distal in group B was(2.17±0.15)cm,there was no significant difference between the two groups(P>0.05).The number of removed lymph nodes in group A was(14.1±3.8),the number of removed lymph nodes in group B was(13.1±2.1),the difference between the two groups was not statistically significant(P>0.05).The length of stay in group A was(29.9±12.9)days,and the length of stay in group B was(28.6±7.6)d,the difference between the two groups was not statistically significant(P>0.05);the hospitalization expenses of the patients in group A were(5.10±1.03)million yuan,and the hospitalization expenses of patients in group B were(7.57±1.37)yuan,and there was a statistical difference between the two groups Scientific significance(P=0.000);the postoperative exhaust time of group A patients was(4.7±1.6)days,and the postoperative exhaust time of patients in group B was(3.2±1.6)days.There was a statistically significant difference between the two groups(P=0.000);the first time to get out of bed after operation for group A patients was(2.71±0.53)d,and the time for group B to get out of bed for the first time after operation was(3.48±1.21)days after operation,the difference between the two groups was statistically significant(P=0.002);the time for patients in group A to resume eating after operation was(3.42±1.02)days,and the time for patients in group B to resume eating after operation was(6.58±3.8)days,the difference between the two groups was statistically significant(P=0.000);The VAS pain score of group A on the first day after operation was(3.55 0±26),VAS pain score of group B was(5.45 1±29),the difference between the two groups was statistically significant(P=0.000);There was a statistically significant difference in anal function between the two groups at 6 months after surgery(P<0.05),but there was no statistical difference in anal function between the two groups at 12 months after surgery(P>0.05).Patients in both groups were alive without local recurrence.Conclusion:NOSES-Ⅰ type E method is a safe surgical method for the treatment of ultra-low rectal cancer.Compared with laparoscopic low anterior rectal resection,the patient’s hospitalization costs are low and postoperative recovery Faster,not only speeds up the patient’s recovery speed,but also reduces the patient’s financial burden;(2)Both surgical methods both preserve the patient’s anus,although patients undergoing laparoscopic low anterior resection 6 months after surgery have excellent anal function In patients treated with NOSES-Ⅰ type E,but after anal recovery exercise under the guidance of a doctor,there was no significant difference in anal dysfunction between the two groups of patients after 12 months.(3)The NOSES-Ⅰ type E method has no anastomosis operation in the abdominal cavity,and there is no risk of anastomotic leakage,so there is no need for preventive ileostomy.In summary,the NOSES-Ⅰ type E method has the advantages of fast recovery,low treatment cost,no risk of anastomotic leakage,and no preventive ileostomy in the treatment of ultra-low rectal cancer.At the same time,compared with laparoscopic low anterior resection,the same rate of radical resection can be achieved,and the short-term effect is similar.It deserves clinical attention and promotion... |
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