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直肠癌
腹腔镜
切除
自然
腔道
标本
取出
危险
因素
分析
岳德亮
安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Feb,27(2)杂志,2015,48(4):246-257.10RUNDE D.Calculated decisions:national institutes of health stroke scale(NIHSS)J.Emerg Med Pract,2019,21(Suppl 6):D1-D3.11YOSHIDA K,MIYAMOTO S.Stratification by multidimensional approach for rational treatment of asymptomatic carotid stenosis(SMART-K Study):study protocol J.Neurologia Medico-chirurgica,2020,60(1):10-16.12YOKOTA C,SAWAMURA T,WATANABE M,et al.High levels of soluble lectin-like oxidized low-density lipoprotein receptor-1 in acute stroke:an age-and sex-matched cross-sectional studyJ.Journal of Atherosclerosis and Thrombosis,2016,23(10):1222-1226.13CHAIYAWATTHANANANTHN P,SUWANPRASERT K,MUENGTAWEEPONGSA S.Differentiation of serum sLOX-1 and NO levels in acute ischemic stroke patients with internal carotid artery stenosis and those without internal carotid artery stenosisJ.J Med Assoc Thai,2016,99(Suppl 4):S48-S53.14BERGE E,WHITELEY W,AUDEBERT H,et al.European stroke organisation(ESO)guidelines on intravenous thrombolysis for acute ischaemic stroke J.Eur Stroke J,2021,6(1):-.15LI X,JIN P,XUE J,et al.Role of sLOX-1 in intracranial artery stenosis and in predicting long-term prognosis of acute ischemic strokeJ/OL.Brain and Behavior,2018,8(1):e879.DOI:10.1002/brb3.879.16BARRETO J,KARATHANASIS SK,REMALEY A,et al.Role of LOX-1(lectin-like oxidized low-density lipoprotein receptor 1)as a cardiovascular risk predictor:mechanistic insight and potential clinical useJ.Arteriosclerosis,Thrombosis,and Vascular Biology,2020,41(1):153-166.17程启慧,余丹,杨国帅,等.H型高血压合并急性缺血性脑卒中患者血清可溶性凝集素样氧化型低密度脂蛋白受体-1、网膜素-1 水平变化及意义 J.实用医学杂志,2019,35(3):346-349.18徐耑,孔岩,蔡秀英,等.心房颤动与急性缺血性卒中静脉溶栓致出血转化的相关性及危险因素分析 J.中风与神经疾病杂志,2015,32(5):415-418.19CHILDS BG,LI H,VAN DEURSEN JM.Senescent cells:a therapeutic target for cardiovascular disease J.The Journal of Clinical Investigation:The Official Journal of the American Society for Clinical Investigation,2018,128(4):1217-1228.(收稿日期:2021-07-06,修回日期:2021-08-26)引用本文:岳德亮,王道岭,刘宇.直肠癌腹腔镜前切除术经自然腔道标本取出的危险因素分析 J.安徽医药,2023,27(2):374-377.DOI:10.3969/j.issn.1009-6469.2023.02.037.直肠癌腹腔镜前切除术经自然腔道标本取出的危险因素分析岳德亮,王道岭,刘宇作者单位:信阳市中心医院普通外科,河南 信阳464000摘要:目的 探讨直肠癌腹腔镜前切除术经自然腔道取出标本手术(NOSES)的危险因素。方法 回顾性分析信阳市中心医院2016年1月至2018年6月收治直肠癌病人104例,均尝试在直肠前切除术中经自然腔道取出标本,采用单因素和多因素法寻找经自然腔道标本取出的独立影响因素。结果 104例病人术中经自然腔道标本取出成功共33例;单因素分析结果显示,体质量指数(BMI)、肿瘤梗阻有无、肿瘤距肛缘长度、肿瘤长径及直肠系膜前后径与直肠癌病人经自然腔道标本取出结局有关(P0.05);多因素分析结果显示,BMI25 kg/m2、无肿瘤梗阻、肿瘤距肛缘长度5 cm、肿瘤长径5 cm及直肠系膜前后径6 cm均是直肠癌病人经自然腔道标本取出结局独立保护因素(P0.05)。结论 直肠癌病人直肠前切除术中经自然腔道标本取出结局与BMI、肿瘤梗阻有无、肿瘤距肛缘长度、肿瘤长径及直肠系膜前后径独立相关;术前应综合评估病人相关临床因素以筛选出NOSES手术合适人群。关键词:直肠肿瘤;经自然腔道手术;腹腔镜;影响因素Risk factor analysis of laparoscopic anterior resection for rectal cancer via natural cavity specimen extractionYUE Deliang,WANG Daoling,LIU YuAuthor Affiliation:Department of General Surgery,Xinyang Central Hospital,Xinyang,Henan 464000,ChinaAbstract:Objective To investigate the risk factors for natural cavity specimen extraction surgery(NOSES)via laparoscopic anterior resection for rectal cancer.Methods A retrospective analysis of 104 patients with rectal cancer admitted to Xinyang Central Hospital from January 2016 to June 2018 was performed to retrieve specimens via the natural cavity during anterior resection,and univariate and multivariate methods were used to explore the independent influencing factors on the retrieval of specimens via natural cavity.Re临床医学374安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Feb,27(2)sults A total of 33 patients were successfully removed intraoperatively via the natural cavity specimens in 104 patients.Univariate analysis showed that body mass index(BMI),presence of tumor obstruction,length of tumor from anal margin,maximum tumor diameter and anteroposterior mesenteric diameter were related to the outcome of patients with rectal cancer via natural cavity specimen extraction(P0.05).Multivariate analysis showed that BMI25 kg/m2,absence of tumor obstruction,length of tumor from anal margin 5 cm,maximum tumor diameter 5 cm and anteroposterior mesenteric diameter 6 cm were all independent protective factors for the outcome of rectal cancer patients via natural cavity specimen extraction(P0.05).Conclusions The outcome of natural cavity specimen extraction was independently correlated with BMI,tumor obstruction,length of tumor from the anal margin,maximum tumor diameter and anterior and posterior rectal mesenteric diameter in patients with rectal cancer.A comprehensive evaluation of patient-related clinical factors should be performed preoperatively to screen the appropriate population for NOSES surgery.Key words:Rectal neoplasms;NOSES;Laparoscopy;Influencing factors近年来结直肠癌腹腔镜手术技术获得长足进展,经自然腔道取出标本手术(NOSES)已逐渐取代常规腹腔镜手术成为临床治疗首选1。NOSES手术与常规腹腔镜手术相比具有美容效果佳、切口感染/切口疝发生风险低、术后疼痛轻及术后康复快等优势2;但该类手术标本经直肠取出时可能出现直肠残端损伤,对于超重/肥胖、直肠系膜肥厚或肿瘤体积过大人群制约较大,其中肿瘤直径较大病人因肠壁增厚使得直肠残端通过难度增加,超重/肥胖人群腹腔脂肪组织过多或淋巴结肿大引起直肠系膜增厚亦使得操作困难3-4。本次研究回顾性分析104例直肠癌病人临床资料,探讨直肠癌腹腔镜前切除术经自然腔道标本取出的危险因素,报告如下。1资料与方法1.1一般资料纳入信阳市中心医院2016年1月至2018年6月收治直肠癌病人104例,均尝试在直肠前切除术中经自然腔道取