探讨经自然腔道取标本手术（NOSES）在3D腹腔镜直肠癌超低位前切除术中的安全性、有效性。

回顾性分析2018年1月至2020年12月期间同济大学附属上海东方医院胃肠肛肠外科接受3D腹腔镜直肠癌超低位前切除术患者80例的临床资料，根据手术方式不同分为两组：术中经自然腔道取标本手术组（NOSES组）34例；传统腹腔镜腹部辅助切口手术组（传统组）46例，两组均行预防性末端回肠造口术，比较两组的手术安全性及近期疗效。

两组资料在年龄、性别、身体质量指数、肿瘤直径、肿瘤部位、肿瘤分期比较，差异均无统计学意义（P＞0.05）；NOSES组与传统组相比在术中出血量（t=0.192，P=0.848）、手术时间（t=1.527，P=0.131）、术后并发症发生率（χ²=1.368，P=0.850）、术后首次排气时间（t=1.126，P=0.263）、术后进食流质时间（t=0.863，P=0.391）、术后病理学检查（χ²=0.224，P=0.894）结果差异均无统计学意义。两组在术后住院时间对比，NOSES组明显低于对照组［（9.97±2.58）天 vs.（12.28±3.80）天，t=3.064；P=0.003］，差异有统计学意义。对比术后第1至3天切口疼痛程度，NOSES组术后疼痛VAS评分明显低于对照组，两组间差异有统计学意义（术后1天：t=3.586，P=0.001；术后2天：t=2.942，P=0.004；术后3天：t=2.792，P=0.007）。根据WIS评分，在随访时间超过1年的64例患者中，49例（76.6%）患者术后肛门功能良好（WIS评分≤10分），无严重肛门失禁患者。

两组手术方式均为符合肿瘤根治性原则的有效手术，手术效果相当。经自然腔道取标本3D腹腔镜直肠癌超低位前切除术在减轻术后切口疼痛、缩短术后住院时间方面具有优势，是安全可行的手术方式。

To assess the safety and efficacy of natural orifice specimen extraction surgery(NOSES) of 3D laparoscopic ultra-low anterior resection for low rectal cancer.

We retrospectively analyzed the clinical and pathological features of 80 patients undergoing 3D laparoscopic ultra-low anterior resection for low rectal cancer during January 2018 to December 2020 in Gastrointestinal and Colorectal Surgery Department of Shanghai East Hospital affiliated to Tongji University. All patients were divided into two groups according to the surgical methods: thirty-four cases were divided into the NOSES group who underwent natural orifice specimen extraction surgery of 3D laparoscopic ultra-low anterior resection. Fourty-six cases were divided into traditional group who underwent traditional approach of 3D laparoscopic ultra-low anterior resection. A comparative, retrospective analysis was performed between the two groups in operative safety index and efficacy.

Age, gender, body mass index, tumor location, diameter of tumor, tumor stage were not significantly different between the two groups(P＞0.05); As compared to the traditional group, there were no significant difference between two groups in terms of blood loss(t=0.192, P=0.848), operation time(t=1.527, P=0.131), postoperative complications(χ²=1.368, P=0.850), first anal exhaust time(t=1.126, P=0.263), postoperative eating liquid time(t=0.863, P=0.391) and postoperative pathology features(χ²=0.224, P=0.894). NOSES group was associated with significantly less estimated mean postoperative hospitalization time [(9.97±2.58) days vs.(12.28±3.80) days, t=3.064; P=0.003]. The VAS score of the incision pain of the first to third day after operation in group NOSES was significantly lower than that in traditional group (postoperative 1d: t=3.586, P=0.001; postoperative 2d: t=2.942, P=0.004; postoperative 3d: t=2.792, P=0.007). According to WIS criteria, there were 76.6% patients whose anal sphincter function was good (WIS≤10), and there was no patient with serious anal incontinence.

By using both two surgical methods, radical resection of tumors could be achieved effectively in accordance with the principles of TME, and the operative effect was comparable. NOSES of 3D laparoscopic ultra-low anterior resection for low rectal cancer has advantages in less estimated postoperative incision pain and postoperative hospitalization time, it is a safe and reliable treatment.