经自然腔道取标本手术在结直肠癌根治性手术中的应用与患者康复效益分析OA

Objective To analyze the application of natural orifice specimen extraction surgery(NOSES)in radical surgery for colorectal cancer and its effect on patient recovery.Method A retrospective analysis was conducted of the clinical data of 78 patients with colorectal cancer treated in Qidong Traditional Chinese Medicine Hospital from January 2021 to December 2024.According to the surgical procedure,patients who underwent NOSES were assigned to the NOSES group(39 cases),and those who underwent laparoscopic radical resection for colorectal cancer were assigned to the control group(39 cases).The two groups were compared in terms of preventive ostomy rate,intraoperative and postoperative recovery parameters,incidence of postoperative complications,surgical costs and changes in perioperative inflammatory stress indices,and the cost-benefit ratios of the two surgical techniques were evaluated.Result Among the 21 rectal cancer patients in the NOSES group,3 cases(14.29%)underwent a preventive stoma;in the control group of 22 rectal cancer patients,4 cases(18.18%)underwent a preventive stoma.The difference of the preventive stoma rate between the two groups was not statistically significant(χ2=0.118,P=0.731).The operation time in the NOSES group was longer than that in the control group(P＜0.05),while the intraoperative blood loss was less than that in the control group(P＜0.05),the time to first postoperative flatus,time to first ambulation,and time to first oral intake were all significantly earlier than those in the control group(all P＜0.05),the hospital stay was significantly shorter than that in the control group(P＜0.05),the cost of surgery and consumables was higher than that in the control group(P＜0.05),while the costs of medication,bed and nursing,other expenses,and the total hospitalization cost were all significantly lower than those in the control group(all P＜0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(P＞0.05).The visual analogue scale(VAS)scores at postoperative day 1,day 3,and day 7 were significantly higher than the preoperative scores in both groups(all P＜0.05).The VAS scores at postoperative day 1,day 3,and day 7 in the NOSES group were significantly lower than those in the control group at the corresponding time points(all P＜0.05).The levels of C-reactive protein(CRP)and interleukin-6(IL-6)at postoperative day 3 were significantly higher than the preoperative levels(1 day before surgery)in both groups(all P＜0.05).The levels of CRP and IL-6 at postoperative day 3 in the NOSES group were significantly lower than those in the control group at the same time point(all P＜0.05).Calculated based on the total hospitalization cost and hospital stay,NOSES saved 2 804.43 yuan per day,meaning that for each hospital day shortened by NOSES,2 804.43 yuan in medical costs was saved.The high-quality recovery rate was 82.05%(32/39)in the NOSES group and 56.41%(22/39)in the control group.The incremental cost-effectiveness ratio(ICER)for NOSES was-29,641.20,indicating an absolute cost-effectiveness advantage.The hospital stay in the NOSES group was shortened by 2.71 days,with an input-output ratio of 2.975 vs.1.Conclusion In radical surgery for colorectal cancer,NOSES has significant advantages in promoting postoperative recovery,alleviating postoperative pain and stress responses,and reducing medical costs.Further shortening operative time and reducing surgical and consumable expenses are important approaches to improving the cost-benefit ratio of NOSES.