对家族性腺瘤性息肉病（FAP）患者预防性手术治疗的手术方式进行改良，改善患者术后生活质量。

回顾性分析江苏省肿瘤医院2019年6月至2020年3月FAP患者的临床资料，均行改良经自然腔道取标本手术（NOSES）。术中游离全结直肠系膜，裸化直肠至肛提肌平面后闭合器离断直肠，置入保护套经直肠断端拉出全大肠；距离回盲部5 cm离断回肠，于回肠末端置入吻合器钉砧；外翻直肠处理远端直肠息肉；随后行端端吻合。收集并分析患者性别、身高、体重及病理结果，术后1个月、3个月及6个月的排便情况。

4位患者均顺利完成改良NOSES术，行腹腔镜下无辅助切口全结肠加部分直肠切除术，无中转开腹。所有患者顺利康复，术后未发生吻合口漏、大出血等术后重大并发症。无术后腹腔感染。吻合口距离肛门的距离与排便频率尤其是夜间排便频率有负相关趋向。

本术式符合无菌无瘤原则，无较大手术后并发症，术后排便功能较好。后期仍需进一步大规模研究证实手术效果。

To improve the quality of life of patients suffered from familial adenomatous polyposis (FAP), we modify the preventive surgical method.

A retrospective analysis was performed on patients with FAP in Jiangsu Cancer Hospital from June 2019 to March 2020, of which natural orifice specimen extraction surgery (NOSES) was conducted. During the operation, the whole colorectal mesentery was dissociated, the rectum was freed and cut to the plane of the levator ANI. We insert the protective cover and pull out the whole large intestine and rectum through the end of the rectum. We cut the intestine 5 cm away from the ileocecal region and put the anvil at the end of the ileum. Then we reverse the rectum to treat the rectal polyps. At last, we do the end-to-end anastomosis. We collect and analyze the data of gender, height, weight, tumor markers, postoperative ventilation time, defecation situation at the first month, the third month and the sixth month after surgery.

Four patients were received modified NOSES successfully, laparoscopic resection of the colorectum. All patients recover successfully, without anastomotic leakage and massive bleeding and other big postoperative complications. No postoperative abdominal cavity infections were found. The distance from the anastomosis to the anus was negatively associated with the frequency of defection, especially at night.

The modified NOSES follows the aseptic and tumor-free principle. No major complications were found in our cases. The defecation function was improved significantly. Still, large-scale studies were needed in the future.