介绍本中心腹腔镜直肠癌根治术、自然腔道取标本手术（NOSES）中，采用TEM器械联合塑料保护套经肛门取标本的经验，并对其中的技术要点及争议问题进行阐述。

回顾分析吉林大学第一医院2017年9月至2018年1月收治的进展期直肠癌手术患者7例，记录肿瘤大小（最大直径），手术时间，术中出血量，清扫淋巴结数目，术后排气时间等近期疗效指标。

本组7例患者均顺利完成直肠癌的NOSES，采用TEM器械联合塑料保护套经肛门取标本获得成功，肿瘤直径5~6.5 cm，手术时间为120~150 min，出血量50~100 ml，清扫淋巴结数目为15~27枚，术后肛门排气时间2~4 d，术后进食流质时间3 d，术后均无并发症发生。

TEM器械联合塑料保护套经肛门能取出较大直肠癌标本，降低取出标本难度，取得良好的近期疗效。

To introduce the experience of using the TEM apparatus integrating the plastic protective sleeve to take out specimen through the anus in the laparoscopic radical resection of rectal cancer (natural orifice specimen extraction surgery, NOSES), and expounds the key technical points and controversial issues.

A retrospective analysis was performed on 7 patients with advanced rectal cancer treated in our hospital from September 2017 to January 2018. The size of the tumor (maximum diameter), the operative duration, the amount of bleeding, the number of lymph nodes harvested, postoperative first time to return of flatus, and so on were recored.

All the 7 patients in this group successfully completed the operation of NOSES by using the TEM apparatus integrating plastic protective sleeve to take out the specimen through the anus, the diameter of the tumor was 5~6.5 cm, the operative duration was 120~150 min, the amount of bleeding 50~100 ml, the number of lymph nodes harvested were 15~27, and the postoperative first time to return of flatus was 2~4 d, after the operation. The time of taking liquid was 3 d, and no complications occurred after operation.

The TEM apparatus integrating plastic protective sleeve can take out large rectal cancer specimens through anus, reduce the difficulty of removing specimens, and achieve good short-term curative effect.