引用文本：陈创奇. 经自然腔道取标本手术中标本取出的常见问题及对策[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(2): 201-208.

作者：陈创奇

单位：中山大学附属第一医院胃肠外科中心结直肠外科，广东 广州 510080

Authors：Chen Chuangqi

Unit：Department of Colorectal Surgery, Gastrointestinal Surgery Center, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong, China

摘要：

经自然腔道取标本手术（natural orifice specimen extraction surgery, NOSES）被称为“微创手术中的微创”技术，是一项凝聚外科医生智慧的创新性微创技术，也充分体现了外科医生对患者最大程度的人文关怀。NOSES包括盆腹腔内肿瘤根治性切除或病变切除、腹腔内完成消化道重建（管型或线型吻合）和标本经自然腔道（直肠、阴道或口腔）取出三大手术操作关键环节，其中标本是否能经自然腔道取出是决定NOSES能否开展的最核心因素，也是NOSES操作成败的关键所在。本文根据自身临床实践经验，结合最新的文献资料，探讨NOSES经自然腔道取出标本中的常见问题及对策，以提升外科医生开展NOSES的操作技巧和临床经验。NOSES经自然腔道顺利取出标本的前提和首要条件是选择合适的适应证，所切除的肿瘤或病变标本需“早、小、瘦”；需选择适宜的标本取出途径（肛门、阴道或口腔）；取出标本前应充分扩张自然腔道，并可借助合适的药物、器械或设备等以便于取出标本；拉拽标本时力度需适宜，操作需熟练，并严格遵循无瘤、无菌手术原则。应避免为了开展NOSES而损害患者利益或造成并发症，确保手术安全和医疗质量。

关键词：经自然腔道取标本手术；腹腔镜；机器人手术；结直肠肿瘤；胃肿瘤

Abstract：

Natural orifice specimen extraction surgery (NOSES) is known as "the minimally invasive technique within minimally invasive surgeries". It is an innovative minimally invasive technique that embodies the wisdom of surgeons and reflects their utmost humanistic care for patients. NOSES includes three key surgical procedures: radical resection of tumors or lesion resection in the abdominopelvic cavity, completion of gastrointestinal reconstruction (tubular or linear anastomosis) intraperitoneally, and specimen removal through natural orifices (rectum, vagina, or oral cavity). Among them, the feasibility of specimen extraction through a natural orifice is the core factor determining whether NOSES can be performed, and it is also a key determinant of the success or failure of NOSES. Based on our clinical practice experience and the latest literature, this article explores the common problems and countermeasures encountered in NOSES for extracting specimens through natural orifices, aiming to enhance surgeons' operational skills and clinical experience in NOSES. The prerequisite and primary consideration for successful specimen extraction through the natural orifices of NOSES is the selection of appropriate indications, which requires the resected tumor or lesion specimens to be "early-stage, small, and thin". Additionally, it is necessary to select the appropriate route for specimen removal (anus, vagina, or oral cavity), adequately dilate the natural orifice prior to extraction, and employ appropriate drugs, instruments, or equipment to facilitate specimen removal. The pulling force during specimen extraction should be moderate with proficient operation, and strict adherence to the principles of tumor-free and sterile surgery should be followed. Patients' interests should not be compromised nor complications induced for the sake of performing NOSES, so as to ensure both surgical safety and medical quality.

Key words：Natural orifice specimen extraction surgery；Laparoscopy；Robotic surgery；Colorectal neoplasms；Gastric neoplasms

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