【摘要】 目的 探讨传统腹腔镜手术、经自然腔道取标本手术(NOSES)、经括约肌间切除术(ISR)治疗低位直肠癌的效果及对生活质量的影响。方法 2020年1月～2022年6月收治的低位直肠癌病人152例，根据手术方式分为传统腹腔镜组(49例)、NOSES组(51例)和ISR组(52例)。比较三组手术情况、术后恢复状况、疼痛、肛门功能恢复状况、生活质量及并发症情况。结果传统腹腔镜组手术时间为(193.98±12.31)分钟，短于NOSES组的(203.54±15.02)分钟和ISR组的(199.85±11.98)分钟，差异有统计学意义(P<0.05),NOSES组、ISR组手术时间比较差异无统计学意义(P>0.05)。传统腹腔镜组首次排气时间为(60.21±10.05)小时、首次下床活动时间为(37.52±6.21)小时、术后住院时间为(12.51±1.47)天，均长于NOSES组的(51.06±8.67)小时、(30.13±4.92)小时和(11.27±1.23)天、ISR组的(53.19±9.24)小时、(28.97±4.71)小时、(11.73±1.35)天，差异有统计学意义(P<0.05)。NOSES组、ISR组首次排气时间、首次下床活动时间、术后住院时间比较差异无统计学意义(P>0.05)。三组术后4小时、术后24小时、术后48小时的疼痛视觉模拟量表(VAS)评分比较差异无统计学意义(P>0.05);三组术后24小时的VAS评分高于术后4小时、术后48小时，差异有统计学意义(P<0.05),三组术后48小时的VAS评分高于术后4小时，差异有统计学意义(P<0.05)。NOSES组术后3个月Wexner评分[(4.93±0.76)分]、术后6个月的Wexner评分[(3.21±0.42)分]均低于ISR组[(6.32±0.93)分、(4.48±0.54)分]、传统腹腔镜组[(5.93±0.81)分、(4.01±0.53)分](P<0.05),传统腹腔镜组术后3个月、术后6个月的Wexner评分均低于ISR组，差异有统计学意义(P<0.05);三组术后6个月的Wexner评分均低于术后1个月、术后3个月，差异有统计学意义(P<0.05),三组术后3个月的Wexner评分均低于术后1个月，差异有统计学意义(P<0.05)。NOSES组术后3个月EORTC QLQ-C30评分为(74.82±4.01)分、6个月的EORTC QLQ-C30评分为(85.49±4.93)分，高于ISR组的(67.05±5.03)分、(71.64±4.21)分，传统腹腔镜组的(70.42±3.92)分、(76.28±4.48)分，差异有统计学意义(P<0.05),传统腹腔镜组术后3个月、6个月的EORTC QLQ-C30评分高于ISR组，差异有统计学意义(P<0.05);三组术后6个月的EORTC QLQ-C30评分高于术前、术后3个月，差异有统计学意义(P<0.05),三组术后3个月的EORTC QLQ-C30评分均高于术前，差异有统计学意义(P<0.05)。三组总并发症发生率比较，差异无统计学意义(P>0.05)。结论 与低位直肠癌传统腹腔镜手术比较，NOSES、ISR术式可加快术后肠功能恢复，且NOSES术式在肛门功能恢复、获取更佳满意的生活质量方面更具优势。更多还原

【Abstract】 Objective To investigate the effects of traditional laparoscopic surgery, natural orifice specimen extraction surgery(NOSES),and intersphincteric resection(ISR) on treatment outcomes and quality of life in patients with low rectal cancer.Methods A total of 152 patients with low rectal cancer who were admitted from January 2020 to June 2022,and they were divided into the traditional laparoscopic group(49 cases),the NOSES group(51 cases),and the ISR group(52 cases) according to the surgical method.The operation status, postoperative recovery status, pain, anal function recovery status, quality of life and complications were compared in the 3 groups.Results The operation time of the traditional laparoscopic group [(193.98±12.31) min] was lower than that of the NOSES group [(203.54±15.02) min] and the ISR group [(199.85±11.98) min](P<0.05),operation time of NOSES group and ISR group was no difference(P>0.05).The first exhaust time [(60.21±10.05) h],the first time of getting out of bed [(37.52±6.21) h],and the length of postoperative hospital stay [(12.51±1.47) d] in the traditional laparoscopic group were all higher than those in the NOSES group [(51.06±8.67) h,(30.13±4.92) h, and(11.27±) 1.23) d] and ISR group [(53.19±9.24) h,(28.97±4.71) h,(11.73±1.35) d](P<0.05),and there were no statistically significant differences in the first exhaust time, the first time to get out of bed, and the length of postoperative hospital stay between the NOSES and ISR groups(P>0.05). There was no statistically significant difference in the Visual Analogue Scale(VAS) scores for pain at 4 hours, 24 hours, and 48 hours after surgery among the three groups(P>0.05).The VAS scores of the three groups at 24 hours after surgery were higher than those at 4 hours and 48 hours after surgery, and the difference was statistically significant(P < 0.05).The VAS scores of the three groups at 48 hours after surgery were higher than those at 4 hours after surgery, and the difference was statistically significant( P < 0.05).The NOSES group’s Wexner score [(4.93±0.76) points] at 3 months after surgery and Wexner score [(3.21±0.42) points] at 6 months after surgery were lower than those of the ISR group [(6.32±0.93) points,(4.48±0.54) points] and the traditional laparoscopic group [(5.93±0.81) points,(4.01±0.53)points](P<0.05),and the Wexner score of the 3 groups at 3 months after surgery was lower than that at 1 month after surgery(P<0.05).The EORTC QLQ-C30 score of the NOSES group at 3 months after surgery was(74.82±4.01) points, and that at 6 months was(85.49±4.93) points, which were higher than those of the ISR group [(67.05±5.03) points and(71.64±4.21) points] and the traditional laparoscopic group [(70.42±3.92) points,(76.28±4.48) points](P<0.05),and the EORTC QLQ-C30 scores of the traditional laparoscopic group at 3 and 6 months after surgery were higher than those of the ISR group, and the difference was statistically significant(P < 0.05). The EORTC QLQ-C30 score of the 3 groups at 6 months after surgery was higher than that before surgery and 3 months after surgery(P<0.05),and the EORTC QLQ-C30 score of the 3 groups at 3 months after surgery was higher than that before surgery(P<0.05).There was no significant difference in the incidence of total complications among the three groups(P>0.05).Conclusion Compared with traditional laparoscopic surgery for low rectal cancer, the NOSES and ISR methods accelerate postoperative bowel function recovery, and the NOSES methods have advantages in anal function recovery and better and satisfactory quality of life.更多还原