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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2024, Vol. 13 ›› Issue (01) : 63 -67. doi: 10.3877/cma.j.issn.2095-3224.2024.01.010

NOSES专栏

经自然腔道取标本手术（NOSES）在结直肠癌日间手术中的应用探索
李凯1, 朱志1, 周海涛2, 王俊3, 杨野4, 赵鑫5, 谷金蓉5, 智冬梅4, 王世洋4, 高梓茗1, 张鑫炜1, 赵睿涵1, 王锡山6,†(), 王振宁1,†()   
  1. 1. 110001　沈阳，国家肿瘤区域医疗中心-中国医学科学院肿瘤医院辽宁医院　中国医科大学第一附属医院胃肠肿瘤外科
    2. 110001　沈阳，国家肿瘤区域医疗中心-中国医学科学院肿瘤医院辽宁医院　中国医科大学第一附属医院胃肠肿瘤外科；100021　北京，国家癌症中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科
    3. 1100001　沈阳，中国医科大学第一附属医院麻醉科
    4. 1100001　沈阳，中国医科大学第一附属医院老年医学科综合外科病房
    5. 1100001　沈阳，中国医科大学第一附属医院手术室
    6. 100021　北京，国家癌症中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科
  • 收稿日期:2023-12-09 出版日期:2024-02-25
  • 通信作者: 王锡山, 王振宁
  • 基金资助:
    国家重点研发计划，前沿生物技术专项(No. 2023YFC3403804); 北京希望马拉松专项基金重点课题(No. LC2022A01); 中国医学科学院肿瘤医院，"希望之星"人才项目; 中国医学科学院医学与健康科技创新工程-重大协同创新项目(No. 2021-I2M-1-010)

Exploration of the natural orifice specimen extraction surgery (NOSES) in ambulatory surgery for colorectal cancer

Kai Li1, Zhi Zhu1, Haitao Zhou2, Jun Wang3, Ye Yang4, Xin Zhao5, Jinrong Gu5, Dongmei Zhi4, Shiyang Wang4, Ziming Gao1, Xinwei Zhang1, Ruihan Zhao1, Xishan Wang6,†(), Zhenning Wang1,†()   

  1. 1. Department of Gastrointestinal Surgery, the First Hospital of China Medical University, Shenyang 110001, China
    2. Department of Gastrointestinal Surgery, the First Hospital of China Medical University, Shenyang 110001, China; Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
    3. Department of Anesthesia, the First Hospital of China Medical University, Shenyang 110001, China
    4. Department of Geriatric Surgery, the First Hospital of China Medical University, Shenyang 110001, China
    5. Department of Operating Room, the First Hospital of China Medical University, Shenyang 110001, China
    6. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Received:2023-12-09 Published:2024-02-25
  • Corresponding author: Xishan Wang, Zhenning Wang
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李凯, 朱志, 周海涛, 王俊, 杨野, 赵鑫, 谷金蓉, 智冬梅, 王世洋, 高梓茗, 张鑫炜, 赵睿涵, 王锡山, 王振宁. 经自然腔道取标本手术（NOSES）在结直肠癌日间手术中的应用探索[J]. 中华结直肠疾病电子杂志, 2024, 13(01): 63-67.

Kai Li, Zhi Zhu, Haitao Zhou, Jun Wang, Ye Yang, Xin Zhao, Jinrong Gu, Dongmei Zhi, Shiyang Wang, Ziming Gao, Xinwei Zhang, Ruihan Zhao, Xishan Wang, Zhenning Wang. Exploration of the natural orifice specimen extraction surgery (NOSES) in ambulatory surgery for colorectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(01): 63-67.

经自然腔道取标本手术（NOSES）和加速康复外科（ERAS）的核心理念都是为了能够减少手术创伤和应激，让患者达到快速康复的目的。日间结直肠手术是两者结合的进一步发展，在规范开展高质量手术的前提下，结合ERAS理念的实施，内容包含术前准备，麻醉与镇痛，外科与营养干预及术后康复的全程团队管理。近期，中国医科大学附属第一医院在二者的优化结合方面做了一些探索，通过微创手术、麻醉疼痛管理、全程护理，再加上严格的术前准备、完整的术后随访，使得手术患者的身心应激和创伤最小化。本文以一名直肠癌NOSES手术患者为例，探讨日间手术模式开展结直肠癌根治术的可行性与影响因素。

关键词: 直肠肿瘤, 结肠肿瘤, 日间手术, 经自然腔道取标本手术（NOSES）, 加速康复外科, 微创手术

The core principle behind Natural Orifice Specimen Extraction Surgery (NOSES) and Enhanced Recovery After Surgery (ERAS) is minimizing surgical trauma and stress to expedite patient recovery. Ambulatory colorectal surgery represents an evolution in this approach, merging these concepts under the framework of standardized, high-quality surgical practices. This method encompasses comprehensive preoperative preparation, anesthesia and analgesia, surgical and nutritional interventions, and a team-managed postoperative rehabilitation protocol. Recent initiatives at our institution have sought to refine the synergy between NOSES and ERAS through the adoption of minimally invasive techniques, advanced pain management strategies, and holistic nursing care. This, along with stringent preoperative planning and thorough postoperative follow-up, significantly reduces both the physical and psychological impact on patients undergoing surgery. This paper presents a case study of a rectal cancer patient treated with NOSES to explore the practicality and determinants of executing a day-case surgery model for the radical treatment of colorectal cancer.

Key words: Rectal neoplasms, Colon neoplasms, Day surgery, Natural orifice specimen extraction surgery(NOSES), ERAS, Minimally invasive surgery
图1 患者术前检查及术后腹部切口。1A：结肠镜检查；1B：全腹增强CT检查；1C：盆腔增强MRI检查；1D：术后腹部切口及造口位置
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