摘要
目的探讨基于倾向评分匹配的腹腔镜经自然腔道取标本手术(NOSES)对直肠癌的病理学影响。方法通过倾向评分匹配的研究方式,纳入承德医学院附属医院从2017年2月至2019年10月收治的89例直肠癌患者作为研究对象。根据手术方式的差异分作研究组44例及对照组45例。对照组开展经辅助切口取标本手术治疗,研究组则采用NOSES治疗。分析两组围术期指标水平,术后并发症发生情况,复发、远处转移以及无病生存率,手术前后环氧合酶-2(COX-2)、前列腺素E2(PGE2)、β-连环蛋白(β-catenin)及微小RNA(miR)-21、miR-196a及miR-23a表达水平等方面的差异,计量资料比较采用t检验,计数资料开展χ2检验。结果两组术后感染[2.27%(1/44)比4.44%(2/45)]、肠梗阻[2.27%(1/44)比0(0/45)]、吻合口瘘[2.27%(1/44)比4.44%(2/45)]以及切口疝[0(0/44)比2.22%(1/45)]发生率对比均不明显(χ2=0.322、1.034、0.322、0.989,P>0.05)。两组复发率[4.55%(2/44)比6.67%(3/45)]、远处转移率[4.55%(2/44)比2.22%(1/45)]以及无病生存率[93.18%(41/44)比88.89%(40/45)]对比均不明显(χ2=0.189、0.369、0.501,P>0.05)。两组治疗后COX-2[(27.60±1.23)ng/ml比(44.12±2.37)ng/ml]、[(28.11±1.34)ng/ml比(44.20±2.51)ng/ml]、PGE2[(31.25±1.73)pg/ml比(42.15±2.37)pg/ml]、[(31.36±1.80)pg/ml比(42.35±2.40)pg/ml]以及β-catenin[(41.56±2.73)ng/ml比(61.78±3.81)ng/ml]、[(42.33±2.76)ng/ml比(62.34±3.85)ng/ml]表达水平均低于同组治疗前(t=41.039、24.641、28.616、37.935、24.574、28.336,P<0.05)。两组治疗后表达水平均低于同组治疗前[miR-21(1.03±0.18比4.13±0.56、2.54±0.23比4.09±0.42、miR-196a(1.02±0.25比1.71±0.25、1.27±0.18比1.69±0.31)及miR-23a(0.94±0.25比2.54±0.46)、(1.21±0.17比2.49±0.47),t=34.958、12.946、20.272、21.714、7.860、17.180,P<0.05],且研究组低于对照组(1.03±0.18比2.54±0.23、1.02±0.25比1.27±0.18、0.94±0.25比1.21±0.17,t=34.439、5.423、5.970,P<0.05)。结论NOSES治疗直肠癌的中长期疗效和传统腹腔镜手术相当,但患者术后恢复较快。
ObjectiveTo investigate and analyze the pathology of laparoscopic natural orifice specimen extraction surgery(NOSES)and assisted incision specimen removal for rectal cancer based on tendency score matching.MethodsA total of 89 patients with rectal cancer who were admitted to our hospital from February 2017 to October 2019 were included in the study by propensity score matching method.According to the difference of operation methods,44 cases were fallen into study group and 45 cases into control group.The control group was treated with assisted incisions and the study group was treated with NOSES.The differences in perioperative indicators,postoperative complications,recurrence,distant metastasis,disease-free survival rate,and the expression levels of cyclooxygenase-2(COX-2),prostaglandin E2(PGE2),Beta-catenin(β-catenin),and microRNA(miR)-21,miR-196a,miR-23a before and after surgery were analyzed.The t-test was used for measurement data andχ2 test for counting data.ResultsThere was no significant difference between two groups in post-operative infection rate[2.27%(1/44)vs.4.44%(2/45)],the incidence of intestinal obstruction[2.27%(1/44)vs.0(0/45)],anastomotic fistula[2.27%(1/44)vs.4.44%(2/45)]and incisional hernia[0(0/44)vs.2.22%(1/45)],χ2=0.322,1.034,0.322,0.989,P>0.05.There was no significant difference between two groups in the recurrence rates[4.55%(2/44)vs.6.67%(3/45)],distant metastasis rate[4.55%(2/44)vs.2.22%(1/45)]and disease-free survival rate[93.18%(41/44)vs.88.89%(40/45)],χ2=0.189,0.369,0.501,P>0.05.After treatment,COX-2[(27.60±1.23)vs.(44.12±2.37)ng/ml,(28.11±1.34)vs.(44.20±2.51)ng/ml],PGE 2[(31.25±1.73)vs.(42.15±2.37)pg/ml,(31.36±1.80)vs.(42.35±2.40)pg/ml],andβ-catenin[(41.56±2.73)vs.(61.78±3.81)ng/ml,(42.33±2.76)vs.(62.34±3.85)ng/ml]in both groups were lower than those before the same treatment(t=41.039,24.641,28.616,37.935,24.574,28.336,P<0.05).After treatment,the expression of miR-21(1.03±0.18 vs.4.13±0.56 and 2.54±0.23 vs.4.09±0.42),miR-196a(1.02±0.25 vs.1.71±0.25,1.27±0.18 vs.1.69±0.31)and miR-23a(0.94±0.25 vs.2.54±0.46,1.21±0.17 vs.2.49±0.47)in both groups was lower than that before treatment,t=34.958,12.946,20.272,21.714,7.860,17.180,P<0.05),and that in the study group was lower than in the control group(1.03±0.18 vs.2.54±0.23,1.02±0.25 vs.1.27±0.18,0.94±0.25 vs.1.21±0.17,t=34.439,5.423,5.970,P<0.05).ConclusionThe long-term curative effect of NOSES in the treatment of rectal cancer is comparable to that of traditional laparoscopic surgery,but the postoperative recovery of NOSES is faster and may have higher clinical application value.
作者
李文熙
郑鑫
孙宝信
张海生
朱志达
赵恩宏
Li Wenxi;Zheng Xin;Sun Baoxin;Zhang Haisheng;Zhu Zhida;Zhao Enhong(Department of Gastrointestinal Surgery,Affiliated Hospital of Chengde Medical College,Chengde 067000,China)
出处
《中华实验外科杂志》
CAS
2024年第8期1840-1843,共4页
Chinese Journal of Experimental Surgery
基金
国家自然科学基金青年项目(81804141)
承德市科学技术研究与发展计划项目(202006A085)。
关键词
直肠癌
经自然腔道取标本手术
经辅助切口取标本手术
疗效
Rectal cancer
Natural orifice specimen extraction surgery
Assisted incision for specimen extraction
Curative effect
