引用文本：中国医师协会结直肠肿瘤专业委员会, 中国抗癌协会大肠癌专业委员会, 中国NOSES研究协作组. 经自然腔道取标本之超低位直肠癌精准功能保肛（NOSES-PPS）手术操作标准（2024版）[J/CD]. 消化肿瘤杂志(电子版), 2025, 17(1):9-15.

Authors: Colorectal Cancer Committee of the Chinese Medical Association, Colorectal Cancer Committee of the Chinese Anti-cancer Association, China NOSES Research Collaborative Group

摘要：

经自然腔道取标本之超低位直肠癌精准功能保肛术（NOSES-PPS）是一种在传统腹腔镜低位直肠癌手术基础上，借助特制透明螺纹扩肛器及其配套设备，在直视下经肛完成肿瘤下缘精确定位和切除，并通过精准管型吻合器结合手工进行消化道重建，从而实现超低位直肠癌精准功能保肛的新型手术技术。目前，NOSES-PPS已在全国多个省市广泛开展，累计完成超500例，相关研究成果在国内外专业学术期刊发表，并获得同行认可。然而，作为一种全新的直肠癌保肛手术，NOSES-PPS的具体操作细节，尚缺乏权威的临床实践指导意见。由中国医师协会结直肠肿瘤专业委员会、中国抗癌协会大肠癌专业委员会和中国NOSES研究协作组共同组织牵头，集合国内数十家大型医疗中心的结直肠肿瘤相关领域专家，经过多次函询和线下讨论会，最终制定了本操作标准，并对NOSES-PPS的定义、器械平台要求、适应证、操作要领、围手术期及术后并发症处理等问题进行了详细阐述，以助于推进NOSES-PPS在临床中的规范化开展。

关键词：直肠肿瘤，超低位；经自然腔道取标本手术；精准功能保肛术；标准

Abstract：

Natural orifice specimen extraction surgery of precision functional sphincter-preserving surgery for ultra-low rectal cancer (NOSES-PPS) is an innovative surgical technique that builds upon traditional laparoscopic surgery for low rectal cancer. This method utilizes a specially designed transparent screw-thread anal dilator and associated equipment to achieve precise tumor localization and resection through direct visualization via the anus. Digestive tract reconstruction is then accomplished using a combination of a precision circular stapler and manual suturing, thereby preserving sphincter function in patients with ultra-low rectal cancer. NOSES-PPS has been widely adopted across multiple provinces and cities in China, with over 500 cases successfully performed to date. The technique and its outcomes have been published in both national and international peer-reviewed journals, receiving significant recognition from the medical community. However, as a novel approach to rectal cancer surgery, there is currently a lack of authoritative clinical practice guidelines detailing the specific procedural steps of NOSES-PPS. To address this gap, the Colorectal Tumor Committee of the Chinese Medical Association, the Colorectal Cancer Committee of the Chinese Anti-cancer Association, and the China NOSES Research Collaborative Group have jointly led an effort to establish standardized guidelines for NOSES-PPS. This initiative involved the collaboration of experts in colorectal oncology from numerous large medical centers across China. Through multiple rounds of consultation and discussion, these experts have developed a comprehensive set of guidelines that detail the definition of NOSES-PPS, requirements for instrumentation, indications, key operative techniques, and the management of perioperative and postoperative complications. This guideline aims to promote the standardized implementation of NOSES-PPS in clinical practice.

Key Words:  Rectal neoplasms, ultra-low rectal cancer; Natural orifice specimen extraction surgery; Precision functional sphincter-preserving surgery; Criteria

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