Transvaginal Natural Orifice Specimen Extraction (NOSE) in Laparoscopic Colorectal Surgery: A Single Institute Experience

腹腔鏡結直腸手術後經陰道標本提取術（transvaginal NOSE）：單一機構之經驗

林毓冰(Yu-Bing Lim) ； 張伸吉(Sheng-Chi Chang) ； 陳奕彰(Yi-Chang Chen) ； 蔡元耀(Yuan-Yao Tsai) ； 陳宏彰(Hung-Chang Chen) ； 王輝明(Hwei-Ming Wang) ； 陳自諒(William Tzu-Liang Chen) ； 柯道維(Tao-Wei Ke)

《中華民國大腸直腸外科醫學會雜誌》 32卷3期 (2021/09) Pp. 114-122

https://doi.org/10.6312/SCRSTW.202109_32(3).11008

摘要

Purpose. Transvaginal natural orifice specimen extraction (NOSE) in laparoscopic colorectal surgery has been attracting attention as a minimally invasive surgery for colorectal cancer recently. The objective of this study was to evaluate the feasibility and short-term clinical outcomes of transvaginal NOSE. Methods.We retrospectively analyzed patient records in our registry database who underwent transvaginal NOSE in laparoscopic colorectal surgery between 2011-2020.We included female patients with diverticulitis, colon polyp, and colon tumor size less than 6 cm. Patients with intact hymen, pregnancy, advanced tumor, middle/low rectal tumor, and disagreement of transvaginal NOSE were excluded. Patients characteristics, short-term surgical outcome, intraoperative and postoperative complications were analyzed. Results. Transvaginal natural orifice specimen extraction (NOSE) in laparoscopic colorectal surgery was performed in 38 patients. The mean duration of surgery was 255.79 ± 80.35 mins, for right-sided colon was 253.57 ± 78.67 minutes and 258.53 ± 84.73 minutes for left-sided colon. The mean duration of hospital stay was 5.82 ± 2.93 days, 6.33 ± 3.22 days for right-sided colon surgery and 5.18 ± 2.48 days for left-sided colon surgery. The mean time to first flatus was 1.42 ± 0.68 days, 1.48 ± 0.81 for right-sided colon and 1.35 ± 0.49 for the left-sided colon. Post-operative complications were recorded, included 2 cases (5.26%) anastomosis leakage, 1 case (2.63%) postoperative ileus, 1 case (2.63%) intra-abdominal wound infection, 1 case colon perforation (2.63%), 1 case (2.63%) colovaginal fistula. There was no intraoperative complication, post-operative urinary tract infection, wound incision hernia, sexual dysfunction or dyspareunia reported. Conclusion. From our preliminary results show transvaginal NOSE in laparoscopic colorectal surgery is an alternative choice for selected cases. But this surgical technique requires more clinical evidence and long-term follow-up.

關鍵字

Laparoscopic ； Colorectal ； Surgery ； Transvaginal ； NOSE

並列摘要

前言：近年來，腹腔鏡結直腸手術後經陰道標本提取術式（transvaginal NOSE）已引起關注。這項研究的目為評估腹腔鏡結直腸手術後經陰道標本提取術式的可行性，安全性和短期臨床結果。方法：我們回顧性分析了數據庫中2011年至2020年間行腹腔鏡結直腸手術後經陰道標本提取術式的患者記錄。我們納入了罹患憩室炎、結腸息肉和結腸腫瘤小於6cm的女性患者。我們也排除了處女膜完整、妊娠、晚期腫瘤、中／低位直腸腫瘤和不同意進行腹腔鏡結直腸手術後經陰道標本提取術式的患者，並且針對患者的特徵、短期手術結果、術中和術後併發症進行回顧性分析。結果：共38位患者行腹腔鏡結直腸手術後經陰道標本提取術式。平均手術時間為255.79 ± 80.35分鐘，次分析右側結腸為253.57 ± 78.67分鐘，左側結腸為258.53 ± 84.73分鐘。平均住院時間為5.82 ± 2.93天，次分析右側結腸手術為6.33 ± 3.22天，左側結腸手術為5.18 ± 2.48天。第一次排氣的平均時間為1.42 ± 0.68天，次分析右側結腸為1.48 ± 0.81，左側結腸為1.35 ± 0.49。記錄術後併發症，包括吻合口漏2例（5.26%），術後腸梗阻1例（2.63%），腹腔內感染1例（2.63%），結腸穿孔1例（2.63%），1例（2.63%）陰道直腸瘻管。無術中併發症、術後尿路感染、切口疝氣、性功能障礙、性交痛等併發症。結論：從我們的初步結果來看，腹腔鏡結直腸手術後經陰道標本提取手術對於部分病患可以是另一種替代選擇。但這種手術技術需要更多的臨床證據和長期隨訪。

並列關鍵字

腹腔鏡 ； 大腸直腸科 ； 手術 ； 經陰道 ； 經自然孔標本摘除術

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