分析经自然腔道取标本手术（NOSES）与非NOSES腹腔镜直肠癌根治术后腹盆腔冲洗液肿瘤细胞检测及细菌培养结果及其临床意义。

前瞻性纳入2018年6月至2019年8月在北京市大兴区人民医院普外科胃肠组行腹腔镜直肠癌根治术的患者。根据患者治疗意愿将所有患者分为NOSES组和非NOSES组，NOSES组共纳入30例患者，非NOSES组纳入50例患者。两组患者一般资料、肿瘤特点差异无统计学意义。所有患者均于气腹建立后（术前）、吻合完成后（术毕）两个时间点冲洗术区，并留取腹腔冲洗液。术前冲洗液即刻送病理科查找肿瘤细胞。术毕冲洗液分装两份，分别即刻送病理科查找肿瘤细胞和检验科行细菌培养。收集肿瘤细胞学检测及细菌培养结果的数据。

NOSES组与非NOSES组患者术前腹腔冲洗液肿瘤细胞阳性例数分别为0例、1例，阳性率分别为0%（0/30）、2.0%（1/50），两组之间比较差异无统计学意义（P>0.05）；术毕腹腔冲洗液肿瘤细胞阳性例数均为0例。NOSES患者与非NOSES患者术毕腹腔冲洗液细菌培养阳性分别为9例、14例，阳性率分别为30%（9/30）、28%（14/50），两组之间差异无统计学意义（χ²=0.037, P=0.848）。

与非NOSES手术相比，NOSES直肠癌根治未增加腹盆腔肿瘤细胞脱落风险及细菌污染风险。值得临床推广应用。

Analysis of tumor cell detection and bacterial culture results of pelvic flushing fluid and its clinical significance after natural orifice specimen extraction surgery (NOSES) and non-NOSES in laparoscopic rectal cancer radical surgery.

From June 2018 to August 2019, patients accepting laparoscopic radical resection of rectal cancer in Department of Gastrointestinal Group General Surgery People′s Hospital of Daxing District were prospectively included into our research. All the patients were divided into NOSES group and non-NOSES group according to wish for treatment, thirty patients in NOSES group, and 50 patients in non-NOSES group. There was no significant difference in demographic and tumor characteristics between two groups. All the patients underwent rinsing of the operation area and retaining of the peritoneal flush fluid after the establishment of pneumoperitoneum (preoperative) and after completion of anastomosis (surgery completed). The flushing fluid preoperatively was immediately sent to the pathology department to find tumor cells. Flushing fluid after surgery was divided in two portions, and immediately sent to the pathology department to find tumor cells and the laboratory department for bacterial culture. Data on tumor cytology and bacterial culture results were collected.

In patients accepting NOSES and non-NOSES, the peritoneal flushing fluid tumor cells preoperatively were positive in 0 case and 1 case respectively, and the positive rate were 0%(0/30) and 2.0%(1/50) respectively, there was no significant difference between the two groups (P>0.05). The peritoneal flushing fluid tumor cells postoperatively wasn′t found in patients accepting NOSES or non-NOSES. In patients accepting NOSES and non-NOSES, the bacterial culture of the peritoneal flushing fluid postoperatively was positive in 9 cases and 14 cases respectively, and the positive rate were 30%(9/30) and 28%(14/50) respectively, and there was no significant difference between the two groups (χ²=0.037, P=0.848).

Compared with non-NOSES surgery, NOSES surgery doesn′t increase the risk of abdominal pelvic tumor cells shedding and bacterial contaminationin, which is worthy of clinical application.