经自然腔道取标本手术（NOSES）可实现结直肠癌手术腹壁无辅助切口，其中，经阴道取标本NOSES（Tv-NOSES）主要应用于女性结直肠癌患者，可弥补经肛门NOSES对大体积标本取出受限的不足。受性别条件限制、特有手术并发症、高级别循证证据缺乏等多重因素影响，该术式的临床推广仍存在争议。本文检索2014—2026年国内外有关结直肠癌Tv-NOSES的临床研究文献，从技术发展、手术操作要点、适应证与禁忌证、围手术期短期疗效、肿瘤学安全性、特有并发症、现存问题及未来研究方向进行叙述性综述。Tv-NOSES在严格筛选的女性结直肠癌患者中具有微创优势，可降低腹壁切口相关并发症，但存在盆腔感染、直肠-阴道瘘、阴道切口相关损伤等特有手术风险。目前高质量多中心随机对照研究匮乏，现有证据多来自单中心回顾性队列研究。临床实践应当遵循相关指南，坚持肿瘤根治优先原则，完善术前评估与充分知情同意。未来需开展高质量临床研究，统一评价指标，进一步明确该术式真实获益-风险比，推动Tv-NOSES规范化个体化实施。

Natural orifice specimen extraction surgery (NOSES) enables abdominal wall auxiliary-incision-free resection. Transvaginal natural-orifice specimen extraction surgery (Tv-NOSES) is mainly used in female patients with colorectal cancer, which can overcome the limitations of transanal NOSES in the removal of large volume specimens. The operation is limited by gender, specific complications and insufficient high-level evidence, and the clinical promotion is still controversial. A literature search was conducted to collect domestic and international clinical studies regarding transvaginal natural-orifice specimen extraction surgery (Tv-NOSES) for colorectal cancer published from 2014 to 2026. This narrative review summarizes evidence from the perspectives of technical evolution, key surgical procedural points, indications and contraindications, short-term perioperative efficacy, oncological safety, procedure-specific complications, existing challenges and future research directions.Tv-NOSES confers minimally-invasive benefits in strictly screened female patients with colorectal cancer, which can reduce abdominal incision-related complications, but there are specific risks such as pelvic infection, rectovaginal fistula, and vaginal incision-related injury. Currently, high-quality multicenter randomized controlled trials are lacking, and available evidence is mostly derived from single-center retrospective cohort studies. Clinical practice should strictly comply with relevant guidelines, prioritize oncological radicality, optimize preoperative assessment, and obtain adequate informed consent. Future high-quality clinical investigations with unified outcome measures are warranted to further clarify the genuine benefit-risk profile of Tv-NOSES and facilitate its standardized and individualized application.