直肠充气试验+美蓝试验在直肠癌TME术中的应用研究  

The Application of Air Leak Test Combined with Methylene Blue Solution Leak Test in Detection of Anastomotic Leakage after Total Mesorectal Excision in Rectal Cancer

作　　者：陈玉祥[1] 黄卫[1] 李俊[1] 方向[1] 黄国飞[1] 

机构地区：[1]四川省德阳市人民医院普三科,四川德阳618000

出　　处：《中国普外基础与临床杂志》2013年第9期1034-1037,共4页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省卫生厅科研课题(项目编号:120418)~~

摘　　要：目的探讨直肠充气试验+美蓝试验在直肠癌全直肠系膜切除(TME)术中检测吻合口漏的作用。方法 2010年3月至2013年3月期间笔者所在医院科室收治直肠癌患者132例,将其随机分为直肠充气试验组(充气组)65例和直肠充气试验+美蓝试验组(充气+美蓝组)67例,2组均遵循TME原则行Dixon术。充气组在行TME术及肠吻合完毕后,用肠钳在吻合口上端2 cm处钳夹肠管,于盆腔内倒入蒸馏水500 mL;经肛门置入24#Foley尿管,向尿管球囊注水使球囊膨胀封闭肛门,使吻合肠段处于相对封闭状态;再经尿管注入气体50 mL,观察水面有无气泡出现,若有气泡则表示存在吻合口漏,并予以修补,至无气泡出现。充气+美蓝组患者则在充气组的基础上加行美蓝试验,吸出盆腔内的蒸馏水和直肠内气体后,经尿管注入美蓝1支(20 mg)和生理盐水50 mL,观察吻合口有无美蓝漏出。结果充气组术中发现吻合口漏3例(4.62%),均给予了修补;术后发生吻合口漏9例(13.85%),5例经充分引流、禁食及对症治疗后治愈,3例经肛门缝合修补后治愈,1例经横结肠造口、局部引流后治愈。充气+美蓝组经充气试验发现吻合口漏2例,后经美蓝试验发现13例存在吻合口漏,共发现吻合口漏15例(22.39%),均给予修补;术后无一例患者发生吻合口漏。与充气组比较,充气+美蓝组术中吻合口漏的检出率较高(P<0.05),术后吻合口漏的发生率较低(P<0.05)。结论充气试验可发现较大的吻合口漏,而美蓝试验可发现小的吻合口漏和隐性漏,两种试验联合应用可发现吻合口缺陷与漏;直视下修补可有效防止TME术后吻合口漏的发生。Objective To investigate the application of air leak test combined with methylene blue solution leak test in the detection of anastomotic leakage after total mesorectal excision （TME） in rectal cancer. Methods In total of 132 patients with rectal cancer underwent Dixon according to TME in our hospital from Mar. 2010 to Mar. 2013 were enrolled. All patients were randomly divided into air leak test group （n：65） and air leak＋methylene blue solution leak test group （n：67）. The intestinal anastomosis of patients in air leak test group were clamped at 2 cm from the upper end of bowel, then injecting 500 mL distilled water to pelvic, and placing 24# Foley catheter through the anus. The catheter balloon was injected with water to close anus, and then injected with 50 mL gas to find the anastomotic leakage where bubbles happened, and then repaired it. Patients of air leak＋methylene blue solution leak test group were treated with methylene blue solution test in addition. After sucking out of the distilled water in pelvic and gas in the rectum, 1 bottle of methylene blue solution （20 mg） and 50 mL saline were injected, observing the location where the methylene blue solutionleaking out and repaired it. Results Three cases （4. 62%） of anastomotic leakage were found during operation in air leak test group, and 9 cases （13.85%） were found after operation. Of the 9 cases, 5 cases were cured with placement of adeq- uate drainage and symptomatic treatment, 3 cases were cured with anal patch, and I case was cured with transverse colon fistula and drainage. In total of 15 cases （22.39%） were found anastomotic leakage, 2 cases of them were found by air leak test and another 13 cases were found by methylene blue solution leak test during operation in air leak＋methylene blue solution leak test group, but no one suffered anastomotic leakage after operation. Compared with air test group, detection rate of anastomotic leakage during operation was higher （P〈0. 05）, and incidence rate of anastomo

关 键 词：直肠癌 充气试验 美蓝试验 吻合口漏 全直肠系膜切除术 预防 

分 类 号：R735.37[医药卫生—肿瘤]