患者男，59岁，身体质量指数25.2 kg/m²，诊断为降结肠近脾曲腺癌合并距肛门5 cm直肠肿瘤。行完全腹腔镜左半结肠癌根治术并经直肠取标本，同期行经肛直肠肿物局部切除术。术中保留肠系膜下静脉，采用双袋法经直肠上段约3 cm切口取出标本。手术时间140 min，出血量20 mL。术后病理示左半结肠中分化腺癌（pT₃N_1b，淋巴结3/14转移，可见神经侵犯，未见明确脉管瘤栓），同一标本另见管状绒毛状腺瘤伴局灶黏膜内中分化腺癌；直肠病灶为0-Ip型管状绒毛状腺瘤伴局灶中分化腺癌（pT₁，黏膜下层头部浸润），切缘阴性，无脉管癌栓及神经侵犯。患者术后第一天下床活动，第六天出院，未发生围手术期并发症。本例提示，经直肠NOSES联合经肛局部切除的一体化策略在严格选择的左半结肠癌合并直肠早癌患者中具有技术可行性。

A 59-year-old man with a body mass index of 25.2 kg/m² was diagnosed with adenocarcinoma of the descending colon near the splenic flexure and a rectal tumor 5 cm from the anal verge. Totally laparoscopic left hemicolectomy with transrectal natural orifice specimen extraction surgery (NOSES) was performed together with transanal local excision of the rectal lesion. The inferior mesenteric vein was preserved, and the specimen was removed through an approximately 3 cm upper rectal incision using a double-bag technique. Operative time was 140 min and blood loss was 20 mL. Pathology showed moderately differentiated adenocarcinoma of the left colon (pT₃N_1b; 3/14 lymph nodes positive; perineural invasion present; no definite lymphovascular invasion), with an additional tubulovillous adenoma containing focal intramucosal carcinoma in the same specimen. The rectal lesion was a 0-Ip tubulovillous adenoma with focal moderately differentiated adenocarcinoma invading the head of the submucosa (pT₁), with negative margins and no lymphovascular or perineural invasion. The patient was discharged on postoperative day 6 without complications. This case suggests that an integrated transrectal NOSES and transanal local excision strategy may be technically feasible in carefully selected patients with synchronous left-sided colon and rectal cancer.