探讨腹腔镜结直肠癌经自然腔道取标本手术(natural orifice specimen extraction surgery，NOSES)肿瘤和肠腔周径测量在评估经直肠拖出标本可行性方面的临床价值。

前瞻性纳入2020年3月至2022年3月，在四川省肿瘤医院胃肠外科拟行腹腔镜体内切除标本经直肠拖出手术的结直肠癌患者31例，术中测量远端肠腔周径和肿瘤标本周径，分析两者差值和经直肠取标本可行性及难易程度的关系。

31例患者中有20例(64.5%)成功实施NOSES，其中13例经直肠轻松取出标本、7例经直肠取标本较为困难；另外11例(35.5%)术中判断无法经直肠取标本，改行常规腹腔镜手术。所有患者术后均顺利恢复，无一例吻合口漏发生，平均术后住院时间(9.9±1.80)d。取出容易组差值平均(2.54±1.63)cm，取出困难组差值平均(0.74±0.79)cm，无法取出组差值平均(－4.11±1.96)cm；相关性分析表明差值与经直肠取标本难易程度呈负相关(r＝－0.835, P<0.001)。

腹腔镜结直肠癌体内切除标本经直肠拖出术中远端肠腔周径和肿瘤标本周径测量真实反映了取标本通道的容积和肿瘤标本的大小，有助于评估经直肠取出标本的可行性及预测其难易程度，值得进一步临床推广。

To explore the clinical value of circumferential diameter measuring of the tumor specimen and its distal intestinal cavity during laparoscopic surgery for colorectal cancer patients with specimen pulled out through the rectum after resection inside the body (NOSES).

31 patients with colorectal cancer who underwent laparoscopic surgery with an intention to pull out specimen through the rectum after body-inside resection in the Department of Gastrointestinal Surgery of Sichuan Cancer Hospital from Mar. 2020 to Mar. 2022 were prospectively included. The circumferential diameter of distal intestinal cavity and the tumor specimen were measured during the operation. The relation between the difference (△) and the feasibility and difficulty of specimen pulling-out was analyzed.

Among the 31 patients, NOSES was successfully completed on 20 cases, of whom the specimen of 13 patients was taken out easily and the specimen of 7 cases was taken out with some difficulty. The other 11 patients who were unable to pull out the specimen through the rectum, therefore, were converted to routine laparoscopic surgery. All patients recovered smoothly after surgery. None anastomotic leakage was observed. The average postoperative hospital stay was (9.9 ± 1.80) days. The average value of △ in patients with specimen easily pulling-out was (2.54±1.63) cm, and in patients with specimen pulling-out with difficulty was (0.74±0.79) cm, and in patients with specimen unable to pull out was (-4.11±1.96) cm. The correlation analysis showed that △ value was negatively correlated with the difficulty of specimen retraction through the rectum (r=-0.835, P< 0.001).

The measurement of the circumferential diameter of the distal intestinal cavity and the tumor specimen during laparoscopic colorectal surgery with specimen pulling-out through the rectum after resection inside the body truly reflects the volume of the specimen retraction channel and the size of the tumor specimen. The measurement method is simple and easy, which helps to evaluate the feasibility and predict the difficulty of specimen retraction, and is worth further clinical promotion.