Short-Term Outcome of Laparoscopic Anterior Resection with Natural Orifice Specimen Extraction (NOSE) for Left-Sided Colon Cancer

左側大腸直腸癌使用經自然孔腔標本取出手術的短期手術結果

謝明皓(Ming-Hao Hsieh) ； 張伸吉(Sheng-Chi Chang) ； 蔡元耀(Yuan-Yao Tsai) ； 吳嘉倫(Chia-Lun Wu) ； 江驊哲(Hua-Che Chiang) ； 柯道維(Tao-Wei Ke) ； 陳自諒(William Tzu-Liang Chen)

《中華民國大腸直腸外科醫學會雜誌》 26卷1期 (2015/03) Pp. 22-29

https://doi.org/10.6312/SCRSTW.2015.26(1).10325

摘要

目的　大腸直腸癌使用經自然孔腔標本取出手術，可以減少腹壁切口，減少術後傷口疼痛，較早恢復腸道功能和減少住院天數。本篇文章將報告左側大腸直腸癌運用經自然孔腔標本取出手術後短期的手術成果，並討論此手術是否為安全及有效的手術方式。方法　從2013年1月至2014年3月，在單一醫院連續收集41例左側大腸直腸腫瘤行經自然孔腔標本取出手術。排除條件為腫瘤大於5公分、腸阻塞或穿孔、或BMI大於33。病人的年齡、性別、腫瘤位置大小、手術過程及術後恢復結果皆列入評估。結果　41位病人其中18位為男性、23位為女性。平均年齡65.7歲，平均BMI為23.9，平均手術時間為226分鐘。腫瘤平均大小為長2.8公分、寬2.1公分。平均術後排氣時間為1.3天，平均術後住院天數為5.2天。一個病人因腸道準備不完全，手術改變成傳統腹腔鏡手術。無手術後死亡案例。但有一例出現腸吻合處滲漏，滲漏比率為2.4%。另有一個病人有發生手術後腹內膿瘍。總計嚴重及輕微併發症發生比率為9.8%。結論　本篇回朔性病例分析的文章顯示，對於有經驗的腹腔鏡手術醫師來說，經自然孔腔標本取出手術運用在左側大腸直腸腫瘤是一個安全且有效的方法。但此手術的好處，仍須前瞻性隨機試驗和傳統腹腔鏡手術比較而得知。

關鍵字

腹腔鏡大腸切除 ； 經自然孔腔標本取出手術 ； 前位切除術

並列摘要

Purpose. Natural orifice specimen extraction (NOSE) after laparoscopic colorectal tumor resection may minimize abdominal mini-incisions, leading to decreased postoperative pain, early bowel function recovery, and shorter hospital stays. We report the short-term outcomes of left-sided colorectal cancer patients who underwent this advanced laparoscopic procedure and examine its safety and feasibility. Methods. Consecutive patients who underwent laparoscopic anterior resection and NOSE for left-sided colorectal cancers were recruited from a single institution from January 2013 to March 2014. Exclusion criteria were a tumor size ＞ 5 cm, complete colonic obstruction, colonic perforation, or a body mass index (BMI) ＞ 33 kg/m^2. Patient characteristics, surgical information, and perioperative data were prospectively collected and retrospectively analyzed. Results. The subjects were 41 patients (18 male and 23 female; median age, 65.7 years; mean BMI, 23.9 kg/m^2). The mean operation time was 226 minutes. Average tumor size was 2.8 (length) 2.1 (width) cm. Postoperatively, the mean time to first flatus was 1.3 days, and the mean hospital stay was 5.2 days. One case with poor bowel preparation was converted to a conventional laparoscopic approach. There were no mortalities. One anastomosis leakage occurred, with a leak rate of 2.4%. Intra-abdominal abscess, prolonged ileus, and urinary tract infection occurred in one patient each. The overall complication rate was 9.8%. Conclusions. Laparoscopic anterior resection and NOSE was safe and feasible for left-sided colon lesions when performed by an expert. Its advantages require elucidation in a prospective randomized comparative study using traditional laparoscopic assisted anterior resection.

並列關鍵字

Laparoscopic colectomy ； Natural orifice specimen extraction ； NOSE ； Anterior resection

參考文獻

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