评价系膜肥厚的低位直肠癌经自然腔道取标本术（NOSES）Ⅰ式手术的改进效果。

选取2021年1月至2023年6月60例行NOSESⅠ式手术的系膜肥厚低位直肠癌患者为研究对象，按照住院病床号随机分为对照组和改进组，每组各30例。对照组行常规腹腔镜直肠癌NOSESⅠ式A法手术，改进组行改进后的腹腔镜直肠癌NOSESⅠ式手术。应用软件SPSS 22.0分析数据，围手术期指标、肛门功能指标等计量资料以（）表示，采用独立样本t检验；并发症发生率等计数资料用[例（%）]表示，采用χ²检验。P<0.05为差异有统计学意义。

改进组在手术时长及住院费用上较对照组显著降低（P<0.05），拖出成功率显著提高（P<0.05），而两组在其他手术相关指标及并发症的总发生率上比较差异均无统计学意义（P>0.05）。时间与方法在大便失禁严重严重程度评分（Wexner评分）、St. Marks大便失禁评分（Vaizey评分）及低位直肠前切除综合征评分(LARS评分)上不存在交互作用（P>0.05）；时间在Wexner、Vaizey及LARS评分上主效应显著（P<0.05）；方法在Wexner、Vaizey及LARS评分上主效应不显著（P>0.05）。

NOSESⅠ式手术的改进在治疗系膜肥厚的低位直肠癌中是安全可行的，在获得与NOSESⅠ式A法手术相当的疗效的同时，具有手术时间短、治疗费用低及拖出成功率高等优势，更值得临床的重视及推广。

To evaluate the efficacy of NOSESⅠ surgery for low rectal cancer with mesangial hypertrophy.

Sixty patients with mesangial hyperplasia and low rectal cancer who underwent NOSESⅠ surgery from January 2021 to June 2023 were selected as study subjects and randomly divided into control group and improved group according to hospital bed number, with 30 patients in each group. The control group underwent conventional laparoscopic NOSESⅠ type A surgery, and the improvement group underwent improved laparoscopic NOSESⅠ type surgery. SPSS 22.0 software was used to analyze the data. Measurement data such as perioperative indexes and anal function indexes were expressed as (), and independent sample t test was used. Statistical data such as complication rate were expressed by [cases (%)] using χ² test. P<0.05 was considered statistically significant.

Compared with the control group, the operation duration and hospitalization cost in the improved group were significantly reduced (P<0.05), and the success rate of pulling out was significantly increased (P<0.05), while there were no statistically significant differences in other operation-related indicators and the total incidence of complications between the two groups (P>0.05). There was no interaction between time and method on the severity of fecal incontinence score (Wexner score), St. Marks fecal incontinence score (Vaizey score) and LARS score (LARS score) (P>0.05). The main effect of time on Wexner, Vaizey and LARS scores was significant (P<0.05). Methods The main effect on Wexner, Vaizey and LARS scores was not significant (P>0.05).

The improvement of NOSESⅠ surgery is safe and feasible in the treatment of low rectal cancer with mesangial hyperplasia, and has the advantages of short operation time, low treatment cost and high success rate of NOSESⅠ surgery, so it deserves clinical attention and promotion.