探讨达芬奇机器人辅助直肠癌切除经自然腔道取标本手术（NOSES）联合多脏器切除术的安全性和可行性。

回顾性收集2013年10月至2021年2月复旦大学附属中山医院结直肠外科收治的使用机器人辅助直肠癌NOSES手术患者的临床资料，选取术中进行多脏器联合切除的11例患者，分析其临床病理特征和围手术期相关结果。

共有11例患者接受机器人辅助直肠癌NOSES手术联合多脏器切除术，其中男性2例（2/11），女性9例（9/11），平均年龄（56.0±11.2）岁，8例低位直肠癌（8/11），2例中位直肠癌（2/11），1例高位直肠癌（1/11）。术前合并糖尿病1例（1/11），高血压2例（2/11），冠心病1例（1/11）。全组患者均顺利完成机器人辅助直肠癌切除NOSES联合多脏器切除术，其中联合全子宫双附件切除4例，联合子宫切除术1例，联合小肠及全子宫双附件切除1例，联合肺转移灶切除1例，卵巢囊肿切除1例，胆囊切除1例，肝ALPPS手术1例，肝叶切除术1例。全组平均手术时间为（175.5±48.2）min，平均出血量为（33.6±19.1）mL。无中转开腹病例，全组无术中输血。所有患者上下切缘与环周切缘均为阴性。无围术期死亡。2例患者（2/11）发生术后并发症（1例小肠不全梗阻，1例肺部感染），均保守治疗后好转。术后平均排气时间（74.2±33.1）小时，术后平均住院时间为（5.9±0.9）天，术后平均辅助治疗开始时间为（18.3±5.4）日。术后病理TNM分期Ⅱ期2例（2/11），Ⅲ期4例（4/11），Ⅳ期5例（5/11）。

有经验的外科团队在合适的直肠癌患者中施行机器人辅助直肠癌切除NOSES联合多脏器切除术安全可行。

To explore the safety and feasibility of Da Vinci robot-assisted natural orifice specimen extraction surgery (NOSES) for the combined resection of rectal cancer with multiple organs.

During October 2013 to February 2021, totally 11 patients undergoing this surgery in the department of colorectal surgery, Zhongshan Hospital of Fudan University were included into presented retrospective study. The analysis content includes the patient's baseline condition, surgery condition, postoperative condition and so on.

Of the 11 patients in the whole group, included 2 males (2/11) and 9 females (9/11) with average age of (56.0±11.2) years, 8 low rectal cancer patients (8/11), 2 middle rectal cancer patients (2/11) and 1 high rectal cancer patients (1/11). One case (1/11) had diabetes mellitus, 2 cases (2/11) had hypertension and 1 case (1/11) had coronary heart disease. Whole group of patients were successfully completed robot assisted NOSES combined multiple organ resection of rectal cancer excision, which combined the uterus double appendix resection in 4 cases, combined hysterectomy in 1 case, combined the small intestine and the uterus double appendix resection in 1 case, combined lung metastases resection in 1 case, ovarian cyst resection in 1 case, cystic resection in 1 case, liver ALPPS surgery in 1 case, lobe resection in 1 case. The mean operation time was (175.5±48.2) min and the mean blood loss was (33.6±19.1) mL. No patient was transferred to laparotomy, and no intraoperative blood transfusion was found in the whole group. The upper and lower margins and circumferential margins were negative in all patients. There were no perioperative deaths. Postoperative complications occurred in 2 patients (2/11) (1 case intestinal insufficiency obstruction, 1 case pulmonary infection), all of which improved after conservative treatment. The mean postoperative exhaust time was (74.2±33.1) hours, the mean postoperative hospital stay was (5.9±0.9) days, and the mean postoperative adjuvant treatment start time was (18.3±5.4) days.Postoperative pathological TNM stages were stage Ⅱ in 2 patients (2/11), stage Ⅲ in 4 patients (4/11) and stage Ⅳ in 5 patients (5/11).

It is safe and feasible to perform robot-assisted NOSES multiple organ resection for eligible patients with rectal cancer under comprehensive evaluation.