直肠癌经自然腔道取标本手术在肛门–直肠功能方面的保护
Natural Orifice Specimen Extraction Surgery in the Protection of Anorectal Function in Rectal Cancer

近年来，在ERAS理念与微创技术推动下，经自然腔道取标本的推广愈加广泛，在追求手术安全性和有效性的同时，更注重了对器官功能的保护。本文围绕直肠癌患者NOSES的肛门–直肠功能保护展开，术前经直肠MRI、肛门指检等评估肿瘤与括约肌状况以确定手术范围；术中依患者情况选合适NOSES术式，取出标本时扩张润滑通道；术后定期复查直肠指诊及多项肛门功能检查，对肛门功能恢复欠佳者行盆底肌训练、电刺激治疗等，早期开始功能锻炼康复。NOSES技术的优势已获得学术界的广泛认同，然而其在临床应用中需进行多维度的综合评估与判断。此外，为确保肛门–直肠功能得到妥善保护，必须基于科学且系统的诊疗方案，以期为直肠癌患者术后生活质量的提升提供更佳的保障。
In recent years, driven by the ERAS concept and minimally invasive techniques, the promotion of specimen extraction through natural orifices has become increasingly widespread. While pursuing surgical safety and effectiveness, there is also a greater emphasis on protecting organ function. This article focuses on the anal-rectal function protection of NOSES (Natural Orifice Specimen Extraction Surgery) in rectal cancer patients. Preoperative assessment of the tumor and sphincter condition through rectal MRI and anal examination determines the scope of surgery; during the operation, the appropriate NOSES procedure is selected based on the patient’s condition, and the specimen is extracted by expanding and lubricating the channel; postoperative regular rectal examinations and multiple anal function tests are conducted, and for those with poor anal function recovery, pelvic floor muscle training, electrical stimulation therapy, etc. are performed, starting functional exercise rehabilitation early. The advantages of NOSES technology have been widely recognized by the academic community. However, its clinical application requires comprehensive evaluation and judgment from multiple dimensions. In addition, to ensure proper protection of anal-rectal function, it is necessary to base on a scientific and systematic diagnosis and treatment plan, with the aim of providing better assurance for improving the quality of life of rectal cancer patients after surgery.