- 期刊
Natural Orifice Specimen Extraction during Colorectal Surgery: A Community Hospital Experience
地區醫院大腸直腸手術使用經自然孔腔標本取出的短期經驗報告
摘要
Purpose. Natural orifice specimen extraction (NOSE) after minimally invasive surgery may minimize abdominal incisions, thus leading to decreased postoperative pain and shorter hospitalization. We examined the safety and feasibility of NOSE in community hospital. Material and Methods. We recruited patients from a single institution from April 2019 to May 2022 who underwent NOSE during laparoscopic or robotic surgery. Patient characteristics, surgical data, and hospitalization data were retrospectively collected and analyzed. Results. Forty-eight patients (31 women and 17 men; median age, 60.3 years; mean body mass index, 23.4 kg/m^2) were included. Five had benign colon lesions and 43 had cancer. Forty-five patients underwent laparoscopic surgery and three patients underwent robotic surgery. The mean operative time was 239.2 minutes for laparoscopic anterior resection (AR) and for low anterior resection (LAR). The surgical procedure included 45 ARs or LARs, one right hemicolectomy, one total colectomy, and one Hartmann procedure. We retracted two specimens via the vagina and the other specimens via the anus. The average specimen length and width were 14.4 cm and 10.2 cm, respectively. For those with cancer, the average tumor length and width were 2.6 cm and 2.0 cm, respectively. Postoperatively, the mean time to first flatus was 1.7 days, the mean antibiotic usage time was 1.9 days, and the mean hospitalization was 6.8 days. There were no mortalities, morbidities, or local recurrences. Conclusion. NOSE is safe and feasible during colorectal surgery in community hospital.
並列摘要
目的：微創手術合併使用經自然孔腔標本取出，因為減少腹壁切口，因而減少術後傷口疼痛和住院天數。我們報告大腸直腸手術運用經自然孔腔標本取出後的短期成果，並討論是否在地區醫院為安全及有效的手術方式。方法：我們回朔收集從2019年4月至2022年5月，在中國醫藥大學新竹附設醫院實行經自然孔腔標本取出手術患者，分析及報告病人的基本資料、手術相關過程和術後恢復結果。結果：共48位病人，含31位女性、17位男性。平均年齡60.3歲。平均BMI 23.4。43位癌症患者，跟5位大腸良性疾患。3位接受機器手臂手術，45位腹腔鏡手術。腹腔鏡前位或低前位切除術手術時間平均為239.2分鐘。術式涵蓋45位前位切除術或低前位切除術、1位右側大腸切除、1位全大腸切除、1位哈特曼氏手術。除了2個手術檢體是從陰道取出外，其他是從肛門取出。手術標本平均長度為14.4公分，平均寬度（血管長度）為10.2公分。對於43位癌症患者，腫瘤平均大小為長2.6公分、寬2.0公分。術後排氣時間為1.7天，平均抗生素使用1.9天。平均術後住院天數為6.8天。無手術後併發症及死亡案例。無局部復發案例。結論：在地區醫院臨床實務上，經自然孔腔標本取出手術運用在大腸直腸手術上，是一個安全且有效的方法。