【摘要】 目的 比较经肛门自然腔道取标本术(NOSES-Ⅳ式)与传统腹腔镜手术治疗乙状结肠癌及上段直肠癌的近期疗效、远期生存及肛门功能。方法 采用回顾性队列研究设计，收集2020年1月至2022年12月于中国医学科学院肿瘤医院山西医院接受NOSES-Ⅳ式和传统腹腔镜手术治疗乙状结肠癌及上段直肠癌的病例。通过倾向性评分匹配(PSM)均衡组间基线差异。比较两组围术期指标、术后并发症、肛门功能及生存结局。结果 共纳入234例患者，NOSES组77例，传统腹腔镜组157例。PSM后每组各61例患者进入分析。NOSES组术后胃肠功能恢复时间显著短于传统腹腔镜组(P<0.001),住院时间亦明显缩短[(7.7±1.1) d vs.(9.3±2.3) d,P<0.001]。NOSES组术后镇痛药物使用率更低(24.6%vs.44.3%,P=0.004),术后疼痛评分显著降低(P<0.001),切口相关并发症发生率亦低于传统腹腔镜组(0 vs.6.6%,P=0.041)。中位随访40个月，两组Wexner评分在术后3个月及6个月差异均无统计学意义(均P>0.05)。总生存率(P=0.753)与无病生存率(P=0.836)差异亦无统计学意义。结论 NOSES-Ⅳ式在促进术后康复、减轻疼痛及缩短住院时间方面具有显著优势，且不增加术后肛门功能障碍，远期肿瘤学安全性与传统腹腔镜手术相当。更多还原

【Abstract】 Objective To compare the short-term efficacy, long-term survival, and anal function between transanal natural orifice specimen extraction surgery(NOSES type Ⅳ) and conventional laparoscopic surgery for sigmoid colon cancer and upper rectal cancer. Methods A retrospective cohort study design was adopted. Data were collected from patients who underwent NOSES type Ⅳ or conventional laparoscopic surgery for sigmoid colon cancer and upper rectal cancer at the Shanxi Hospital of Cancer Hospital, Chinese Academy of Medical Sciences, between January 2020 and December 2022. Propensity score matching(PSM) was used to balance baseline differences between groups. Perioperative indicators, postoperative complications, anal function, and survival outcomes were compared between the two groups. Results A total of 234 patients were enrolled, including 77 in the NOSES group and 157 in the conventional group. After PSM, 61 patients from each group were included in the analysis. The NOSES group showed significantly faster postoperative recovery of gastrointestinal function(P<0.001) and a shorter hospital stay [(7.7±1.1) d vs.(9.3±2.3) d, P<0.001] compared with the conventional group. The NOSES group also had a lower rate of postoperative analgesic use(24.6% vs. 44.3%, P=0.004), significantly lower postoperative pain scores(P<0.001), and a lower incidence of incision-related complications(0 vs. 6.6%,P=0.041). After a median follow-up of 40 months, no significant differences were observed in Wexner scores at 3 and 6 months postoperatively(both P>0.05), nor in overall survival(P=0.753) and disease-free survival(P=0.836) between the two groups. Conclusions NOSES type Ⅳ offers significant advantages in promoting postoperative recovery, reducing pain, and shortening hospital stay, without increasing postoperative anal dysfunction, and has comparable long-term oncological safety to conventional laparoscopic surgery.更多还原