完全腹腔镜胃癌根治术中行亚甲蓝检查预防术后吻合口漏的临床研究  

The clinical study of methylene blue examination during totally laparoscopic radical gastrectomy for the prevention of postoperative anastomotic leakage

作　　者：邓春 吴兴康 张伟[2] 赵旭 李小军[2] DENG Chun;WU Xing-kang;ZHANG Wei(Xi’an Medical University,Xi’an 710021,China;Department of General Surgery,Shaanxi Provincial People's Hospital)

机构地区：[1]西安医学院,陕西西安710021 [2]陕西省人民医院普通外科

出　　处：《腹腔镜外科杂志》2021年第7期505-508,516,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨完全腹腔镜胃癌根治术中行亚甲蓝检查对术后吻合口漏的影响。方法:回顾分析2018年1月至2020年12月为502例患者行完全腹腔镜胃癌根治术的临床资料,192例术中经胃管注射亚甲蓝,以检查吻合口完整性(观察组),未注射的310例作为对照组。观察两组术中、术后吻合口漏发生率、术后住院时间及术后30 d内死亡率。结果:观察组中6例(3.1%)术中发现吻合口漏,均予以缝线加强,术后均未出现吻合口漏;两组术后共16例发生吻合口漏,对照组术后吻合口漏发生率(4.5%vs.1.0%,P=0.036)高于观察组,观察组早期吻合口漏发生率(0 vs.2.3%,P=0.048)低于对照组;对照组术后住院时间[9.0(9.0,10.0)d vs.8.0(7.0,8.0)d,P<0.001]长于观察组;两组术后30 d内均无死亡病例。结论:术中行亚甲蓝检查是完全腹腔镜胃癌根治术中评估吻合口完整性的重要方法,可有效减少术后吻合口漏的发生,尤其术后早期吻合技术缺陷相关的吻合口漏。Objective:To investigate the effect of intraoperative methylene blue examination on anastomotic leakage after totally laparoscopic radical gastrectomy.Methods:From Jan.2018 to Dec.2020,clinical data of 502 patients who underwent totally laparoscopic radical gastrectomy were retrospectively analyzed.192 patients,who were injected intraoperative methylene blue via gastric tube for the examination of anastomotic integrity,were separated into observation group.310 patients without injection were in control group.The incidence of intraoperative and postoperative anastomotic leakage,postoperative hospital stay and mortality within 30 d after surgery were observed.Results:Intraoperative anastomotic leakage occurred in 6 patients(3.1%)in the observation group,all were reinforced with sutures and none of them developed postoperative anastomotic leakage.A total of 16 patients in two groups had postoperative anastomotic leakage,and the incidence of postoperative anastomotic leakage was higher in the control group than that in the observation group(4.5%vs.1.0%,P=0.036),and the incidence of early anastomotic leakage was lower in the observation group than that in the control group(0 vs.2.3%,P=0.048),the postoperative hospital stay was longer in the control group than that in the observation group[9.0(9.0,10.0)d vs.8.0(7.0,8.0)d,P<0.001].No patient died within 30 d after surgery.Conclusions:Intraoperative methylene blue examination is an important method for assessing anastomotic integrity during totally laparoscopic radical gastrectomy,it could prevent postoperative anastomotic leakage,especially early postoperative anastomotic leakage associated with defects in the anastomotic technique.

关 键 词：胃肿瘤 胃切除术 腹腔镜检查 吻合口漏 亚甲蓝 

分 类 号：R735.2[医药卫生—肿瘤]