分析我国经自然腔道取标本手术（NOSES）临床应用现况，为规范科学地推广NOSES手术提供重要参考。

基于微信问卷的形式，针对我国从事普通外科、肿瘤外科、妇科、泌尿外科等专业的医师展开调查，包括医师基本情况、NOSES开展情况、开展NOSES面临的挑战以及NOSES技术培训和科研现状。

本次调查覆盖我国31个省份、自治区及直辖市，共收到有效问卷1 710份，其中开展NOSES手术人数为1 166人，占68.2%，未开展NOSES手术人数为544人，占31.8%。开展NOSES手术的医院共有854家，共开展120 835例NOSES手术，其中按学科领域分类，结直肠肿瘤86 430例（71%），胃肿瘤11 574例（10%），妇科肿瘤5 612例（5%），其他良性疾病为17 219例（14%）；按取标本途径分类，经肛门取标本95 553例（79.1%），经阴道取标本23 383例（19.4%），经直肠前壁切开取标本1 375例（1.1%）。按同类手术占比分类，478家医院开展NOSES手术例数占同类手术比例小于10%，317家医院在10%~20%，59家医院在20%以上。调查发现大多数医师接触NOSES技术主要通过大型学术会议（53%），学习NOSES技术主要为参加培训班（42%）和观看专家手术直播演示（38%）。88%的已开展NOSES手术主刀医师认为助手需要去有经验的中心学习NOSES技术，92%的未开展NOSES手术医师认为需要去有经验的中心学习NOSES技术；50.3%的已开展NOSES手术主刀医师认为助手需要学习10~20例手术后可授予独立开展资质，55.3%的未开展NOSES手术医师认为需要学习10~20例手术后可以独立开展该手术。290人开展过NOSES相关课题研究，212人发表过中文论文，125人发表过英文论文，数据库数据上传数量（67人），分别较2022年调查增长42.86%、26.19%、50.60%和131.03%。83.2%和82.7%的医院支持本单位和本单位医师开展NOSES手术，99.5%的经治患者对NOSES手术效果非常满意。

NOSES手术在我国已经得到广泛关注并快速增长，总数超过12万例，学科涵盖结直肠、胃、妇科、肝胆、泌尿等，在医院、医师及患者等层面均产生了积极影响。近年来，中青年医师已成为开展NOSES手术的主力军；非三甲医院的基层医师已具备了常规开展NOSES手术的能力；大型学术会议使更多的医师了解NOSES手术，NOSES技术推广得益于手术演示和培训班；到有资质的培训基地学习将是年轻医生学习成长快速有效的方法。目前，NOSES相关科研文章及课题持续增加，临床研究逐渐起步，将为NOSES技术提供更高级别的循证医学证据。

To analyze the current clinical application status of natural orifice specimen extraction surgery (NOSES) in China, providing important reference for its standardized and scientific promotion.

A WeChat-based questionnaire survey was conducted among physicians specializing in general surgery, oncological surgery, gynecology, and urology across China. The survey covered physician demographics, NOSES implementation status, challenges encountered, and the current state of NOSES technical training and research.

The survey covered 31 provinces, autonomous regions, and municipalities in China, yielding 1 710 valid responses. Among respondents, 1 166 (68.2%) performed NOSES procedures, while 544 (31.8%) did not. A total of 854 hospitals performed NOSES procedures, conducting 120 835 cases. By specialty: colorectal tumors (86 430 cases, 71%); gastric tumors (11 574 cases, 10%); gynecological tumors (5 612 cases, 5%); other benign conditions (17 219 cases, 14%). By specimen retrieval route: 95 553 cases (79.1%) via the anus, 23 383 cases (19.4%) via the vagina, and 1 375 cases (1.1%) via anterior rectal wall incision. By proportion of NOSES procedures among similar surgeries, 478 hospitals performed NOSES procedures accounting for less than 10% of similar surgeries, 317 hospitals performed them between 10% and 20%, and 59 hospitals performed them at over 20%. The survey revealed that most physicians primarily encountered NOSES techniques through large academic conferences (53%). Training methods predominantly involved attending workshops (42%) and watching live surgical demonstrations by experts (38%). 88% of surgeons who have performed NOSES believed that their assistants should receive training in NOSES techniques at experienced centers, while 92% of those who have not performed NOSES agreed that they themselves need to undergo such training. 50.3% of surgeons who have performed NOSES held the view that their assistants can be authorized to independently perform the procedure after completing 10~20 cases of hands-on training, and 55.3% of those who have not performed NOSES believed that they can independently carry out the procedure after such training. 290 individuals conducted NOSES-related research projects, with 212 publishing Chinese papers and 125 publishing English papers. Database data uploads (67 individuals) increased by 42.86%, 26.19%, 50.60%, and 131.03% respectively compared to previous periods. 83.2% and 82.7% of hospitals support their institutions and physicians in performing NOSES procedures, with 99.5% of treated patients expressing high satisfaction with NOSES outcomes.

NOSES surgery has gained widespread attention and experienced rapid growth in China, with over 120 000 procedures performed across disciplines including colorectal, gastric, gynecological, hepatobiliary, and urological surgery. It has generated positive impacts at the hospital, physician, and patient levels. In recent years, young and middle-aged physicians have become the main force performing NOSES procedures; primary-care physicians outside tertiary hospitals have acquired the capability to routinely perform NOSES surgery; major academic conferences have increased awareness of NOSES procedures, with surgical demonstrations and training workshops driving its dissemination. Training at accredited centers remains the most efficient pathway for young physicians to master the technique. Currently, NOSES-related research articles and projects continue to increase, with clinical studies gradually emerging to provide higher-level evidence-based support for the technique.