【摘要】 目的 探讨老年女性患者腹腔镜右半结肠癌根治术经自然腔道取标本在加速康复外科模式中的临床价值。方法 回顾性分析我院2017年9月至2020年9月收治的68例70岁以上进入加速康复外科路径的右半结肠癌女性患者的临床资料，其中30例经阴道取标本腹腔镜右半结肠癌根治术为NOSES组，38例传统腹腔镜右半结肠癌根治术为TLC组，比较两组术中情况、术后恢复情况、血白细胞及血清白蛋白，随访至2022年3月。结果 与TLC组相比，NOSES组手术时间长，术后第1天血白细胞低，术后第1、3天疼痛评分低，术后第1、3、5天血清白蛋白高，术后第一次肛门排气时间短，术后平均住院时间短，两组比较差异有统计学意义（P <0.05）；两组在术中出血、术后并发症发生率、术后3年远处转移率及总生存率的比较，差异无统计学意义（P> 0.05）。结论 老年女性经阴道取标本腹腔镜右半结肠癌根治术是安全的，减轻了术后疼痛，缩短了术后胃肠功能恢复时间及住院时间，在加速康复外科的临床实践中具有重要意义。更多还原

【Abstract】 Objective To investigate the clinical value of total laparoscopic right hemicolectomy with natural orifice specimen extraction(NOSE)using transvaginal specimen extraction in elderly female patients with right colon cancer in the mode of enhanced recovery after surgery(ERAS). Methods A retrospective analysis was conducted using the clinical data of 68 female patients aged more than 70 years with right colon cancer who were admitted to our hospital from September 2017 to September 2020. There were 30 patients in the NOSES group who underwent total laparoscopic right hemicolectomy with transvaginal specimen extraction and 38 patients in the TLC group who underwent traditional laparoscopic right hemicolectomy. The intraoperative condition,postoperative recovery,white blood cell count and serum albumin level were compared between the two groups. The enrolled patients were followed up till March 2022. Results The NOSES group had a longer operation time;lower white blood cell count on the first day after surgery;lower pain scores on the first and third days after surgery;higher serum albumin levels on the first,third and fifth days after surgery;shorter first anal exhaust time after surgery and shorter average postoperative length of hospital stay than the TLC group,with the differences being statistically significant(all P <0.05). However,intraoperative bleeding,postoperative complication rate,postoperative 3-year distant metastasis rate and overall survival rate showed no significant differences between the two groups(all P > 0.05). Conclusion Total laparoscopic right hemicolectomy with transvaginal specimen extraction is a safe therapeutic choice for elderly female patients and can reduce postoperative pain,postoperative gastrointestinal function recovery time and length of hospital stay. It has immense significance in the clinical practice of enhanced recovery after surgery.更多还原