研究快速康复外科（ERAS）理念指导下经自然腔道取标本手术（NOSES）治疗直肠癌的临床效果。

选取本中心在ERAS理念指导下的25例行NOSES直肠癌根治术患者作为研究对象（NOSES-ERAS组），选取同期在传统理念指导下行全腹腔镜直肠癌根治术患者30例作为对照组，评价手术时长、失血量、切口长度、淋巴结清扫数目及切口并发症和下肢静脉栓塞和坠积性肺炎等术后并发症发生率，采用数字分级法NRS方法评价术后疼痛感，SPSS 13.0软件统计分析比较两组之间差异。

实施NOSES直肠癌根治术的ERAS组与对照组比较在淋巴结清扫数目、手术时长、失血量、术后吻合口漏等方面差异均无统计学意义；NOSES-ERAS组切口相关并发症总发生率为低于对照组发生率（χ²=4.101，P<0.05）；NOSES-ERAS组患者术后离床活动时间及平均住院时间均短于对照组（χ²=-11.179，-3.434，P<0.05）；NOSES-ERAS组切口的切口长度短于对照组（t=-42.798，P<0.01），NOSES-ERAS组术后疼痛感NRS评分轻于对照组（t=-26.525，P<0.05），差异均有统计学意义。

ERAS理念指导下的NOSES直肠癌根治术进一步优化了全腹腔镜直肠癌手术的微创化、美容化、功能化、个体化治疗的效果，NOSES直肠癌根治术与ERAS相结合具有更大的优势，值得推广开展，具有良好的应用前景。

To study the clinical effect of the natural orifice specimen extraction surgery (NOSES) surgical treatment of rectal cancer with the concept of enhance recovery after surgery (ERAS).

Twenty-five cases of NOSES radical resection of rectal cancer patients under the guidance of the concept of rapid rehabilitation surgery in our hospital were selected as research subjects (NOSES-ERAS group). We selected 30 cases patients with radical resection of rectal by laparoscopic surgery under the guidance of traditional concept as control group.We evaluated the operation time, blood loss, length of incision, the number of lymph node dissection and wound complications and lower extremity venous embolism and hypostatic pneumonia incidence rate of postoperative complications. NRS method was used to evaluate postoperative pain by SPSS13.0 statistical analysis software.

There were no statistical differences between the NOSES-ERAS group and control goup in comparison with the number of lymph node dissection, operation time, blood loss, postoperative anastomotic leakage and other aspects. The total incidence rate of incision related complications in NOSES-ERAS group was lower than that of control group (χ²=4.101, P<0.05); the incidence of NOSES-ERAS patients after leaving bed time, and hospitalization time were shorter than the control group (χ²=-11.179, -3.434, P<0.05); incision length of NOSES-ERAS group were shorter than the control group (t=-42.798, P<0.01), postoperative pain NRS score of NOSES-ERAS group were lighter than the control group (t=-26.525, P<0.05).

The NOSES radical resection of rectal cancer under the guidance of ERAS achieved more minimally invasive cosmetic and functional, individualized treatment effect in laparoscopic surgery. There is a greater advantage that ERAS combined with the NOSES radical resection of rectal cancer which is worthy of popularization and with good application prospect.