探讨利用套袖式吻合技术的低位直肠癌新辅助放化疗后经自然腔道取标本手术（NOSES）的安全性、可行性及近期疗效。

回顾性分析中国医学科学院北京协和医学院肿瘤医院2018年10月至2021年10月20例利用套袖式吻合技术完成NOSES手术的低位直肠癌新辅助放化疗后患者的临床资料，统计并分析患者的临床特征、手术情况、术后恢复、病理特征、围手术期并发症以及术后复发转移等资料，并分别于术后1个月、3个月及6个月采用低位前切除综合征（LARS）评分量表评估肛门功能。

20例低位直肠癌新辅助放化疗后患者均成功完成利用套袖式吻合技术的NOSES手术，术前肿瘤距肛缘中位距离为4.0 cm，术中未行预防性造口，中位手术时间为171.5 min，中位吻合时间为17.0 min，中位术中出血量为35.0 mL。患者术后中位下地时间、进食时间、排气时间和住院时间分别为18.5 h、12.0 h、30.0 h和7.0 d，中位住院费用为47 678.0元。术后病理显示中位肿瘤长径为3.3 cm，中位近端切缘长度为10.3 cm，中位远端切缘长度为1.0 cm，中位淋巴结检出数目为14.5枚。随访过程中，结肠残端回缩入盆腔的中位时间为11.5 d，其中1例（5.0%）患者于术后第五天出现吻合口漏，另外有3例（15.0%）患者出现肛周粪水性皮炎伴肛周疼痛，均予对症止处理后好转。1例（5.0%）患者术后1年出现肝转移，其余患者无肿瘤局部复发或转移。12例（60%）患者术后1个月LARS评分较高，但术后3个月15例（75%）患者肛门功能较为满意。

利用套袖式吻合技术的低位直肠癌新辅助放化疗后NOSES手术安全可行，避免了预防性造口，经对症指导治疗肛门功能恢复满意，具有较好的近期疗效，其远期疗效待进一步随访观察。

This study aims to explore the clinical feasibility, safety and short-term efficacy of oversleeve anastomosis in natural orifice specimen extraction surgery (NOSES) for low rectal cancer after neoadjuvant chemoradiotherapy.

From October, 2018 to October, 2021, twenty low rectal cancer patients after neoadjuvant chemoradiotherapy were retrospectively enrolled in this study, who underwent NOSES using the oversleeve anastomosis technique in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Data regarding clinical characteristics, surgical outcomes, postoperative recovery, pathological characteristics, perioperative complications, postoperative recurrence and metastasis were collected and analyzed. The low anterior resection syndrome (LARS) score was used to evaluate anal function at the first, third and sixth months after surgery.

We successfully performed NOSES with the oversleeve anastomosis technique in 20 low rectal cancer patients after neoadjuvant chemoradiotherapy without the use of prophylactic stoma. The median distance of the tumor from the anal verge was 4.0 cm. The median operation time was 171.5 minutes, the median anastomosis time was 17.0 minutes and intraoperative blood loss was 35.0 mL. The median time to ground activity, time to fluid diet intake, time to flatus, and length of hospital stay were 18.5 hours, 12.0 hours, 30.0 hours and 7.0 days, respectively. The median hospitalization cost was 47 678.0 RMB. The postoperative pathological reports showed that the median length of tumor was 3.3 cm; the median proximal and distal resection margin was 10.3 cm and 1.0 cm; the median lymph nodes retrieved was 14.5. During the follow-up period, the colonic stump retracted back to the rectal cavity on postoperative day 11.5. One patient (5.0%) experienced anastomosis leakage five day after operation, and three patients (15.0%) experienced perianal fecal dermatitis and anal pain. All of them recovered after symptomatic treatment. One patient (5.0%) had liver metastasis one year after operation, and the other patients had no tumor recurrence or metastasis. LARS was higher in 12 patients (60%) one month after operation, but anal function gradually recovered satisfactorily three months after operation in 15 patients (75%).

This study indicates that NOSES using oversleeve anastomosis shows promise as a safe and feasible procedure with satisfactory short-term outcomes for low rectal cancer after neoadjuvant chemoradiotherapy, avoiding the use of prophylactic stoma. The anal function is satisfactory after symptomatic guidance. But the long-term outcomes need to be explored.