経直腸的自然オリフィス摘出術を用いた低侵襲右コレクトミー：これは次のステップとなり得るか？

Minimally invasive right colectomy with transrectal natural orifice extraction: could this be the next step forward?

• C-C Cheng
• Y-R Hsu
• Y-J Chern
• W-S Tsai
• H-Y Hung
• C-K Liao
• J-M Chiang
• P-S Hsieh
• J-F You

抄録

背景:

右側結腸手術の経膣的自然オリフィス標本採取法（NOSE）は、短期的に良好な転帰を示すことが証明されている。しかし、これまでのところ、経直腸的NOSE法の右側結腸手術に対する利点を報告した研究はない。本研究の目的は、経直腸NOSE法を用いた低侵襲右ヘミコレクトミーと従来のミニラパロトミーによる検体採取の技術的実現性、安全性、短期転帰を比較することであった。

BACKGROUND: The transvaginal natural orifice specimen extraction (NOSE) approach for right-side colon surgery has been proven to exhibit favorable short-term outcomes. However, thus far, no study has reported the advantages of transrectal NOSE for right-side colon surgery. The aim of this study was to compare the technical feasibility, safety, and short-term outcomes of minimally invasive right hemicolectomy using the transrectal NOSE method and those of conventional mini-laparotomy specimen extraction.

方法:

2017年1月から2018年12月までの間に、台湾・林口のChang Gung Memorial Hospitalで悪性腫瘍または良性疾患のいずれかで低侵襲の右血小板摘出術を受けた連続した患者を対象に研究を行った。患者はミニラパロトミーを用いた検体摘出を伴う従来の手術と、NOSE手術の2群に分けられた。合併症、術後短期回復、疼痛強度などの手術成績を解析した。

METHODS: A study was conducted on consecutive patients who had minimally invasive right hemicolectomy either for malignancy or benign disease at Chang Gung Memorial Hospital, Linkou, Taiwan, between January 2017 and December 2018. The patients were divided into two groups: conventional surgery with specimen extraction using mini-laparotomy and NOSE surgery. Surgical outcomes, including complications, postoperative short-term recovery, and pain intensity, were analyzed.

結果:

低侵襲的右血行再建術を受けた 297 例（男性 151 例，平均年齢 64.9±12.8"Zs_A0"years）を登録した．これら297例のうち、272例がミニラパロトミーによる検体採取を伴う従来の手術を受け、25例がNOSE手術を受けた（経直腸23例、経膣2例）。大腸疾患の診断は従来群とNOSE群で有意差はなかった。術後の罹患率、死亡率は同等であった。術後の入院期間は、NOSE群（中央値5"Zs_A0"日、範囲3-17"Zs_A0"日）が従来群（中央値7"Zs_A0"日、範囲3-45"Zs_A0"日）に比べて有意に（p = 0.004）短かった。術後疼痛はNOSE群よりも従来群の方が有意に（術後1日目のp=0.026、術後2日目のp=0.002）大きかった。

RESULTS: We enrolled 297 patients (151 males, mean age 64.9 ± 12.8 years) who had minimally invasive right hemicolectomy. Of these 297 patients, 272 patients had conventional surgery with specimen extraction through mini-laparotomy and 25 patients had NOSE surgery (23 transrectal, 2 transvaginal). The diagnosis of colon disease did not differ significantly between the conventional and NOSE groups. Postoperative morbidity and mortality rates were comparable. The postoperative hospital stay was significantly (p = 0.004) shorter in the NOSE group (median 5 days, range 3-17 days) than in the conventional group (median 7 days, range 3-45 days). Postoperative pain was significantly (p = 0.026 on postoperative day 1 and p = 0.002 on postoperative day 2) greater in the conventional group than in the NOSE group.

結論:

NOSEは従来の手術と同等の短期的な手術成績と関連していた。NOSEは従来の手術よりも術後の創傷痛が少なく、入院期間も短い。より大きな研究が必要である。

CONCLUSIONS: NOSE was associated with acceptable short-term surgical outcomes that were comparable to those of conventional surgery. NOSE results in less postoperative wound pain and a shorter hospital stay than conventional surgery. Larger studies are needed.