经鼻胰管美蓝显影在胰腺肿瘤剜除术中的应用及效果分析  

Analysis of the application and effectiveness of endoscopic nasal pancreatic duct methylene blue staining in pancreatic enucleation

作　　者：张孟哲 张正乐 李汉军 荣愈平[1] 朱忠超 陶京 Zhang Mengzhe;Zhang Zhengle;Li Hanjun;Rong Yuping;Zhu Zhongchao;Tao Jing(Department of Pancreatic Surgery,Renmin Hospital of Wuhan University,Hubei Wuhan 430060,China)

机构地区：[1]武汉大学人民医院胰腺外科,湖北武汉430060

出　　处：《腹部外科》2025年第1期26-29,共4页Journal of Abdominal Surgery

摘　　要：目的 探讨胰腺肿瘤剜除术术中经鼻胰管行美蓝显影的应用效果及可行性。方法 回顾性分析自2020年5月至2024年9月在武汉大学人民医院胰腺外科行术中经鼻胰管美蓝显影的胰腺肿瘤剜除术18例病人的病历资料和随访结果。18例病人中,肿瘤位于胰头颈部15例,体尾部3例;肿瘤最大径为(2.3±0.7) cm,肿瘤边缘距离主胰管的最近距离为(2.2±0.6) mm,18例病人均术前经内镜下放置鼻胰管,术中胰腺肿瘤剜除后,经鼻胰管注入美蓝溶液,观察创面蓝染情况,根据胰液漏出部位选择合适的修补方式,记录分析术后近远期并发症,尤其关注术后胰瘘发生情况。结果 术中注入美蓝溶液发现6例创面蓝染;按国际胰瘘研究组术后胰瘘标准,术后共有10例病人发生胰瘘、生化漏,其中生化漏7例,B级术后胰瘘3例,无C级术后胰瘘发生。结论 经鼻胰管美蓝显影应用于胰腺肿瘤剜除术中,安全可行,有助于及时精准地发现肉眼难以观察的胰液漏出,并及时修补,从而降低以胰瘘为代表的术后并发症风险。Objective To evaluate the feasibility and effectiveness of methylene blue staining via nasopancreatic tube during pancreatic enucleation.Methods A retrospective analysis was conducted on the medical records and follow-up data of 18 patients who underwent pancreatic enucleation with intraoperative methylene blue staining via nasopancreatic tube at the Pancreatic Surgery Department of Renmin Hospital of Wuhan University from May 2020 to September 2024.Among these patients,15 had tumors located in the pancreatic head and neck,and 3 in the body and tail.The maximum tumor diameter was 2.3±0.7 cm,and the shortest distance between the tumor margin and the main pancreatic duct was 2.2±0.6 mm.All patients had nasopancreatic tubes placed preoperatively under endoscopic guidance.During surgery,methylene blue solution was injected through the nasopancreatic tube after tumor enucleation to observe the staining of the pancreatic wound surface.Appropriate repair methods were selected based on the location of pancreatic juice leakage,and postoperative short-and long-term complications were recorded and analyzed,with a particular focus on the occurrence of postoperative pancreatic fistula(POPF).Results Intraoperative injection of methylene blue solution revealed staining of the wound surface in 6 cases.According to the International Study Group on Pancreatic Fistula(ISGPF)criteria for POPF,a total of 10 patients experienced pancreatic fistula and biochemical leak postoperatively.Among these,there were 7 cases of biochemical leak and 3 cases of grade B POPF,without occurrences of grade C POPF.Conclusion The application of methylene blue staining via nasopancreatic tube during pancreatic enucleation is safe and feasible.It facilitates the timely and accurate detection of pancreatic juice leakage that may not be visible to the naked eye,enabling immediate repair and reducing the risk of postoperative complications,particularly pancreatic fistula.

关 键 词：胰腺肿瘤剜除术 美蓝 鼻胰管 胰瘘 胰腺肿瘤 内镜逆行胰胆管造影 

分 类 号：R657.5[医药卫生—外科学]