作者：戴伟钢，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: Dai Weigang，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：

结直肠经自然腔道取标本（NOSES）手术被称为“微创中的微创”技术，目前已经在全世界范围内得到认可和推广。经直肠取标本手术（TASE）依然占据主导地位，受客观因素和主观因素的影响，经阴道取标本手术开展远不及TASE广泛，其独特的优势并未被外科医生充分认识。事实上经阴道取出标本不仅在解剖上操作简单，术后容易愈合，并发症发生率低，而且能允许体积更大的肿瘤标本通过。因此，本文根据自身临床实践经验，结合最新的文献报道，梳理经阴道NOSES手术发展过程，总结经阴道NOSES手术的技术难点和要点，来提高外科医生对此手术方式的认识。

Abstract：

Colorectal natural orifice specimen extraction surgery（NOSES） surgery is called "minimally invasive technology in minimally invasive" and has been recognized and promoted worldwide. Transanal specimen extraction （TASE） is still dominant. Influenced by objective and subjective factors ，transvaginal specimen extraction （ TVSE ） is far less extensive than TASE ， and its unique advantages are not fully recognized by surgeons. In fact，TVSE is not only simple in anatomy，easy to heal after operation，low in complication rate，but also allows larger tumor specimens to pass through. Therefore ，according to our clinical experience and the latest literature reports，we combed the development process of transvaginal NOSES surgery，and summarized the technical difficulties and key points of TVSE，so as to improve the surgeon's understanding of this surgical method.

Key Words:  Natural orifice specimen extraction； Laparoscopy； Colorectal neoplasms；Transvaginal specimen extraction