经自然腔道取标本手术(Natural Orifice Specimen Extraction Surgery, NOSES)避免了腹壁的辅助切口,有极佳的微创效果。与传统腹腔镜手术相比,NOSES在确保彻底切除肿瘤的同时也最大限度地保留了腹壁原有的功能,规避了与腹壁切口相关的...经自然腔道取标本手术(Natural Orifice Specimen Extraction Surgery, NOSES)避免了腹壁的辅助切口,有极佳的微创效果。与传统腹腔镜手术相比,NOSES在确保彻底切除肿瘤的同时也最大限度地保留了腹壁原有的功能,规避了与腹壁切口相关的并发症,具有术后恢复快、疼痛轻、美容效果好以及术后并发症少等优点。文章综合分析了近年来有关文献的研究成果与报道,深入探讨了经自然腔道取标本手术(NOSES)在结直肠癌领域的发展历程、主要分类、适应症与禁忌症、优点与争议等方面,旨在为临床应用提供参考。Natural Orifice Specimen Extraction Surgery (NOSES) eliminates the need for auxiliary abdominal wall incisions, offering exceptional minimally invasive outcomes. Compared to traditional laparoscopic surgery, NOSES ensures complete tumor removal while preserving the abdominal wall’s natural function to the greatest extent, thus sidestepping complications linked to abdominal wall incisions. It boasts advantages such as swift postoperative recovery, minimal pain, excellent cosmetic results, and fewer postoperative complications. This article thoroughly analyzes recent research findings and relevant literature reports, delving into the evolution, primary classifications, indications, contraindications, strengths, and controversies of NOSES in colorectal cancer. The aim is to offer a reference for clinical application.展开更多
经自然腔道取标本手术(natural orifice specimen extraction surgery, NOSES)作为一种新兴的微创手术技术,在结直肠癌的治疗中逐渐受到关注。多项研究和临床实践表明,NOSES在确保肿瘤根治性、淋巴结清扫和术后并发症控制方面,与传统腹...经自然腔道取标本手术(natural orifice specimen extraction surgery, NOSES)作为一种新兴的微创手术技术,在结直肠癌的治疗中逐渐受到关注。多项研究和临床实践表明,NOSES在确保肿瘤根治性、淋巴结清扫和术后并发症控制方面,与传统腹腔镜手术相比具有相当的效果。然而NOSES的推广和普及仍面临一些挑战,包括适应症的选择、技术的标准化以及潜在的肿瘤播散风险等。本文结合了近几年相关文献,将NOSES手术在结直肠癌治疗应用中的优势以及仍存在的争议做一综述,为临床应用提供参考。Natural orifice specimen extraction surgery (NOSES), as a new minimally invasive surgical technique, has attracted more and more attention in the treatment of colorectal cancer. Several studies and clinical practice have shown that NOSES is comparable to traditional laparoscopic surgery in ensuring tumor radical resection, lymph node dissection and postoperative complications control. However, there are still some challenges in the promotion and popularization of NOSES, including the selection of indications, the standardization of technology, and the potential risk of tumor dissemination. Based on the relevant literature in recent years, the advantages and controversies of NOSES in the treatment of colorectal cancer are reviewed, so as to provide reference for clinical application.展开更多
近年来,在ERAS理念与微创技术推动下,经自然腔道取标本的推广愈加广泛,在追求手术安全性和有效性的同时,更注重了对器官功能的保护。本文围绕直肠癌患者NOSES的肛门–直肠功能保护展开,术前经直肠MRI、肛门指检等评估肿瘤与括约肌状况...近年来,在ERAS理念与微创技术推动下,经自然腔道取标本的推广愈加广泛,在追求手术安全性和有效性的同时,更注重了对器官功能的保护。本文围绕直肠癌患者NOSES的肛门–直肠功能保护展开,术前经直肠MRI、肛门指检等评估肿瘤与括约肌状况以确定手术范围;术中依患者情况选合适NOSES术式,取出标本时扩张润滑通道;术后定期复查直肠指诊及多项肛门功能检查,对肛门功能恢复欠佳者行盆底肌训练、电刺激治疗等,早期开始功能锻炼康复。NOSES技术的优势已获得学术界的广泛认同,然而其在临床应用中需进行多维度的综合评估与判断。此外,为确保肛门–直肠功能得到妥善保护,必须基于科学且系统的诊疗方案,以期为直肠癌患者术后生活质量的提升提供更佳的保障。In recent years, driven by the ERAS concept and minimally invasive techniques, the promotion of specimen extraction through natural orifices has become increasingly widespread. While pursuing surgical safety and effectiveness, there is also a greater emphasis on protecting organ function. This article focuses on the anal-rectal function protection of NOSES (Natural Orifice Specimen Extraction Surgery) in rectal cancer patients. Preoperative assessment of the tumor and sphincter condition through rectal MRI and anal examination determines the scope of surgery;during the operation, the appropriate NOSES procedure is selected based on the patient’s condition, and the specimen is extracted by expanding and lubricating the channel;postoperative regular rectal examinations and multiple anal function tests are conducted, and for those with poor anal function recovery, pelvic floor muscle training, electrical stimulation therapy, etc. are performed, starting functional exercise rehabilitation early. The advantages of NOSES technology have been widely recognized by the academic community. However, its clinical application requires comprehensive evaluation and judgment from multiple dimensions. In addition, to ensure proper protection of anal-rectal function, it is necessary to base on a scientific and systematic diagnosis and treatment plan, with the aim of providing better assurance for improving the quality of life of rectal cancer patients after surgery.展开更多
文摘经自然腔道取标本手术(Natural Orifice Specimen Extraction Surgery, NOSES)避免了腹壁的辅助切口,有极佳的微创效果。与传统腹腔镜手术相比,NOSES在确保彻底切除肿瘤的同时也最大限度地保留了腹壁原有的功能,规避了与腹壁切口相关的并发症,具有术后恢复快、疼痛轻、美容效果好以及术后并发症少等优点。文章综合分析了近年来有关文献的研究成果与报道,深入探讨了经自然腔道取标本手术(NOSES)在结直肠癌领域的发展历程、主要分类、适应症与禁忌症、优点与争议等方面,旨在为临床应用提供参考。Natural Orifice Specimen Extraction Surgery (NOSES) eliminates the need for auxiliary abdominal wall incisions, offering exceptional minimally invasive outcomes. Compared to traditional laparoscopic surgery, NOSES ensures complete tumor removal while preserving the abdominal wall’s natural function to the greatest extent, thus sidestepping complications linked to abdominal wall incisions. It boasts advantages such as swift postoperative recovery, minimal pain, excellent cosmetic results, and fewer postoperative complications. This article thoroughly analyzes recent research findings and relevant literature reports, delving into the evolution, primary classifications, indications, contraindications, strengths, and controversies of NOSES in colorectal cancer. The aim is to offer a reference for clinical application.
文摘经自然腔道取标本手术(natural orifice specimen extraction surgery, NOSES)作为一种新兴的微创手术技术,在结直肠癌的治疗中逐渐受到关注。多项研究和临床实践表明,NOSES在确保肿瘤根治性、淋巴结清扫和术后并发症控制方面,与传统腹腔镜手术相比具有相当的效果。然而NOSES的推广和普及仍面临一些挑战,包括适应症的选择、技术的标准化以及潜在的肿瘤播散风险等。本文结合了近几年相关文献,将NOSES手术在结直肠癌治疗应用中的优势以及仍存在的争议做一综述,为临床应用提供参考。Natural orifice specimen extraction surgery (NOSES), as a new minimally invasive surgical technique, has attracted more and more attention in the treatment of colorectal cancer. Several studies and clinical practice have shown that NOSES is comparable to traditional laparoscopic surgery in ensuring tumor radical resection, lymph node dissection and postoperative complications control. However, there are still some challenges in the promotion and popularization of NOSES, including the selection of indications, the standardization of technology, and the potential risk of tumor dissemination. Based on the relevant literature in recent years, the advantages and controversies of NOSES in the treatment of colorectal cancer are reviewed, so as to provide reference for clinical application.
文摘近年来,在ERAS理念与微创技术推动下,经自然腔道取标本的推广愈加广泛,在追求手术安全性和有效性的同时,更注重了对器官功能的保护。本文围绕直肠癌患者NOSES的肛门–直肠功能保护展开,术前经直肠MRI、肛门指检等评估肿瘤与括约肌状况以确定手术范围;术中依患者情况选合适NOSES术式,取出标本时扩张润滑通道;术后定期复查直肠指诊及多项肛门功能检查,对肛门功能恢复欠佳者行盆底肌训练、电刺激治疗等,早期开始功能锻炼康复。NOSES技术的优势已获得学术界的广泛认同,然而其在临床应用中需进行多维度的综合评估与判断。此外,为确保肛门–直肠功能得到妥善保护,必须基于科学且系统的诊疗方案,以期为直肠癌患者术后生活质量的提升提供更佳的保障。In recent years, driven by the ERAS concept and minimally invasive techniques, the promotion of specimen extraction through natural orifices has become increasingly widespread. While pursuing surgical safety and effectiveness, there is also a greater emphasis on protecting organ function. This article focuses on the anal-rectal function protection of NOSES (Natural Orifice Specimen Extraction Surgery) in rectal cancer patients. Preoperative assessment of the tumor and sphincter condition through rectal MRI and anal examination determines the scope of surgery;during the operation, the appropriate NOSES procedure is selected based on the patient’s condition, and the specimen is extracted by expanding and lubricating the channel;postoperative regular rectal examinations and multiple anal function tests are conducted, and for those with poor anal function recovery, pelvic floor muscle training, electrical stimulation therapy, etc. are performed, starting functional exercise rehabilitation early. The advantages of NOSES technology have been widely recognized by the academic community. However, its clinical application requires comprehensive evaluation and judgment from multiple dimensions. In addition, to ensure proper protection of anal-rectal function, it is necessary to base on a scientific and systematic diagnosis and treatment plan, with the aim of providing better assurance for improving the quality of life of rectal cancer patients after surgery.
