• 四川省德陽市人民醫(yī)院普三科(四川德陽 618000);

目的  探討直腸充氣試驗(yàn)+美藍(lán)試驗(yàn)在直腸癌全直腸系膜切除(TME)術(shù)中檢測(cè)吻合口漏的作用。
方法  2010年3月至2013年3月期間筆者所在醫(yī)院科室收治直腸癌患者132例,將其隨機(jī)分為直腸充氣試驗(yàn)組(充氣組)65例和直腸充氣試驗(yàn)+美藍(lán)試驗(yàn)組(充氣+美藍(lán)組) 67例,2組均遵循TME原則行Dixon術(shù)。充氣組在行TME術(shù)及腸吻合完畢后,用腸鉗在吻合口上端2cm處鉗夾腸管,于盆腔內(nèi)倒入蒸餾水500mL;經(jīng)肛門置入24# Foley尿管,向尿管球囊注水使球囊膨脹封閉肛門,使吻合腸段處于相對(duì)封閉狀態(tài);再經(jīng)尿管注入氣體50mL,觀察水面有無氣泡出現(xiàn),若有氣泡則表示存在吻合口漏,并予以修補(bǔ),至無氣泡出現(xiàn)。充氣+美藍(lán)組患者則在充氣組的基礎(chǔ)上加行美藍(lán)試驗(yàn),吸出盆腔內(nèi)的蒸餾水和直腸內(nèi)氣體后,經(jīng)尿管注入美藍(lán)1支(20mg)和生理鹽水50mL,觀察吻合口有無美藍(lán)漏出。
結(jié)果  充氣組術(shù)中發(fā)現(xiàn)吻合口漏3例(4.62%),均給予了修補(bǔ);術(shù)后發(fā)生吻合口漏9例(13.85%),5例經(jīng)充分引流、禁食及對(duì)癥治療后治愈,3例經(jīng)肛門縫合修補(bǔ)后治愈,1例經(jīng)橫結(jié)腸造口、局部引流后治愈。充氣+美藍(lán)組經(jīng)充氣試驗(yàn)發(fā)現(xiàn)吻合口漏2例,后經(jīng)美藍(lán)試驗(yàn)發(fā)現(xiàn)13例存在吻合口漏,共發(fā)現(xiàn)吻合口漏15例(22.39%),均給予修補(bǔ);術(shù)后無一例患者發(fā)生吻合口漏。與充氣組比較,充氣+美藍(lán)組術(shù)中吻合口漏的檢出率較高(P<0.05),術(shù)后吻合口漏的發(fā)生率較低(P<0.05)。
結(jié)論  充氣試驗(yàn)可發(fā)現(xiàn)較大的吻合口漏,而美藍(lán)試驗(yàn)可發(fā)現(xiàn)小的吻合口漏和隱性漏,兩種試驗(yàn)聯(lián)合應(yīng)用可發(fā)現(xiàn)吻合口缺陷與漏;直視下修補(bǔ)可有效防止TME術(shù)后吻合口漏的發(fā)生。

引用本文: 陳玉祥,黃衛(wèi),李俊,方向,黃國(guó)飛. 直腸充氣試驗(yàn)+美藍(lán)試驗(yàn)在直腸癌TME術(shù)中的應(yīng)用研究△. 中國(guó)普外基礎(chǔ)與臨床雜志, 2013, 20(9): 1034-1037. doi: 復(fù)制

1. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence?[J]. Br J Surg, 1982, 69(10):613-616.
2. Heald RJ, Ryall RDH. Recurrence and survival after total mesorectal excision for rectal cancer[J]. Lancet, 1986, 327(8469):1479-1482.
3. Heald RJ, Karanjia ND. Results of radical surgery for rectal cancer[J]. World J Surg, 1992, 16(5):848-857.
4. Bonjer HJ, Hop WC, Nelson H, et al. Laparoscopically assisted vs. open colectomy for colon cancer:a meta-analysis[J]. Arch Surg, 2007, 142(3):298-303.
5. 叢山, 李延茂, 張烈, 等. 腹腔鏡根治性直腸癌切除術(shù)的臨床探討[J]. 腹腔鏡外科雜志, 2009, 14(3):200-201.
6. 廖傳文, 曹虹, 胡淑琴, 等. 粗口徑肛管和亞甲藍(lán)混合液聯(lián)用在預(yù)防直腸癌術(shù)后吻合口漏的臨床研究[J]. 江西醫(yī)藥, 2010, 45(10):961-963.
7. 卞守華, 歐陽衛(wèi)東. 低位直腸癌全直腸系膜切除術(shù)吻合口瘺原因及其防治[J]. 內(nèi)蒙古醫(yī)學(xué)雜志, 2009, 41(1):40-42.
8. 徐忠發(fā), 左文述, 劉奇. 現(xiàn)代肛腸腫瘤外科學(xué)[M]. 濟(jì)南:山東科學(xué)技術(shù)出版社, 1993:211-222.
9. :741-743.
10. Santin AD, Diamandis EP, Bellone S, et al. Overexpression of kallikrein 10 (hK10) in uterine serous papillary carcinomas[J]. Am J Obstet Gynecol, 2006, 194(5):1296-1302.
11. Bellone S, Watts K, Cane’S, et al. High serum levels of interl-eukin-6 in endometrial carcinoma are associated with uterine serouspapillary histology, a highly aggressive and chemotherapy-resistantvariant of endometrial cancer[J]. Gynecol Oncol, 2005, 98(1):.
12. Chan JK, Loizzi V, Youssef M, et al. Significance of comprehensive surgical staging in noninvasive papillary serous carcinoma of the endometrium[J]. Gynecol Oncol, 2003, 90(1):181-185.
13. Thomas MB, Mariani A, Cliby WA, et al. Role of cytoreductionin stageⅢand Ⅳ uterine papillary serous carcinoma[J]. GynecolOncol, 2007, 107(2):190-193.
14. Peeters KC, Tollenaar RA, Marijnen CA, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer[J]. Br J Surg, 2005, 92(2):211-216.
15. 戴東, 顏文貞, 譚小宇, 等. 直腸癌低位吻合口瘺預(yù)防措施的臨床探討[J]. 中華腫瘤防治雜志, 2008, 15(23):1832-1834.
16. 趙廣法, 師英強(qiáng), 莫善兢. 直腸全系膜切除術(shù)后吻合口漏的危險(xiǎn)因素分析和對(duì)策[J]. 腫瘤, 2004, 24(6):595-597.
17. Rullier E, Le Toux N, Laurent C, et al. Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery[J]. World J Surg, 2001, 25(3):274-277.
18. 張洪偉, 王京華, 王為忠, 等. 低位直腸癌保肛術(shù)后吻合口漏9例的原因及治療[J]. 第四軍醫(yī)大學(xué)學(xué)報(bào), 2007, 28(12):1139-1141.
19. Miki K, Sasajima M, Ohtsuka T, et al. Pepsinogen Ⅰ, pepsinogenⅡ, and pepsinogen Ⅰ/Ⅱ ratio[J]. Nihon Rinsho, 2005, 63 Suppl.
20. Giuliano AE, Jones RC, Brennan M, et al. Sentinel lymphadenectomy in breast cancer[J]. J Clin Onco1, 1997, 15(6):2345-2350.
21. 劉新杰, 傅建民, 麥沛成. 美藍(lán)染色法檢測(cè)乳腺癌前哨淋巴結(jié)的臨床研究[J]. 臨床外科雜志, 2003, 11(3):146-148.
22. 陳玉祥, 李俊, 黃衛(wèi), 等. 腸道準(zhǔn)備與結(jié)直吻合口漏的探討[J]. 醫(yī)藥前沿, 2012, 2(13):293-294.
23. 賴百塘, 汪蕙, 湛秀萍, 等. 亞甲藍(lán)體內(nèi)抗腫瘤作用及藥理學(xué)研究[J]. 中華腫瘤雜志, 1989, 11(2):98-100.
24. Wang H, Shah V, Lanks KW. Use of oxidizing dyes in combination with 2-cyanocinnamic acid to enhance hyperthermic cytotoxicity in L929 cells[J]. Cancer Res, 1987, 47(13):3341-3343.
25. 馮樹, 曾青, 周麗娜, 等. 亞甲藍(lán)對(duì)結(jié)腸癌細(xì)胞系Lovo的殺傷和抑制作用[J]. 沈陽藥科大學(xué)學(xué)報(bào), 2000, 17(4):283-285.
26. 張巍峨, 馮明功. 亞甲藍(lán)抑制癌細(xì)胞能量代謝機(jī)制的研究[J]. 華北煤炭醫(yī)學(xué)院學(xué)報(bào), 2011, 13(3):344-345.
27. 傅士羅. 淺談亞甲藍(lán)注射液的四種應(yīng)用及機(jī)制[J]. 基層醫(yī)學(xué)論壇, 2010, 14(35):1120.
28. -98.
  1. 1. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence?[J]. Br J Surg, 1982, 69(10):613-616.
  2. 2. Heald RJ, Ryall RDH. Recurrence and survival after total mesorectal excision for rectal cancer[J]. Lancet, 1986, 327(8469):1479-1482.
  3. 3. Heald RJ, Karanjia ND. Results of radical surgery for rectal cancer[J]. World J Surg, 1992, 16(5):848-857.
  4. 4. Bonjer HJ, Hop WC, Nelson H, et al. Laparoscopically assisted vs. open colectomy for colon cancer:a meta-analysis[J]. Arch Surg, 2007, 142(3):298-303.
  5. 5. 叢山, 李延茂, 張烈, 等. 腹腔鏡根治性直腸癌切除術(shù)的臨床探討[J]. 腹腔鏡外科雜志, 2009, 14(3):200-201.
  6. 6. 廖傳文, 曹虹, 胡淑琴, 等. 粗口徑肛管和亞甲藍(lán)混合液聯(lián)用在預(yù)防直腸癌術(shù)后吻合口漏的臨床研究[J]. 江西醫(yī)藥, 2010, 45(10):961-963.
  7. 7. 卞守華, 歐陽衛(wèi)東. 低位直腸癌全直腸系膜切除術(shù)吻合口瘺原因及其防治[J]. 內(nèi)蒙古醫(yī)學(xué)雜志, 2009, 41(1):40-42.
  8. 8. 徐忠發(fā), 左文述, 劉奇. 現(xiàn)代肛腸腫瘤外科學(xué)[M]. 濟(jì)南:山東科學(xué)技術(shù)出版社, 1993:211-222.
  9. 9. :741-743.
  10. 10. Santin AD, Diamandis EP, Bellone S, et al. Overexpression of kallikrein 10 (hK10) in uterine serous papillary carcinomas[J]. Am J Obstet Gynecol, 2006, 194(5):1296-1302.
  11. 11. Bellone S, Watts K, Cane’S, et al. High serum levels of interl-eukin-6 in endometrial carcinoma are associated with uterine serouspapillary histology, a highly aggressive and chemotherapy-resistantvariant of endometrial cancer[J]. Gynecol Oncol, 2005, 98(1):.
  12. 12. Chan JK, Loizzi V, Youssef M, et al. Significance of comprehensive surgical staging in noninvasive papillary serous carcinoma of the endometrium[J]. Gynecol Oncol, 2003, 90(1):181-185.
  13. 13. Thomas MB, Mariani A, Cliby WA, et al. Role of cytoreductionin stageⅢand Ⅳ uterine papillary serous carcinoma[J]. GynecolOncol, 2007, 107(2):190-193.
  14. 14. Peeters KC, Tollenaar RA, Marijnen CA, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer[J]. Br J Surg, 2005, 92(2):211-216.
  15. 15. 戴東, 顏文貞, 譚小宇, 等. 直腸癌低位吻合口瘺預(yù)防措施的臨床探討[J]. 中華腫瘤防治雜志, 2008, 15(23):1832-1834.
  16. 16. 趙廣法, 師英強(qiáng), 莫善兢. 直腸全系膜切除術(shù)后吻合口漏的危險(xiǎn)因素分析和對(duì)策[J]. 腫瘤, 2004, 24(6):595-597.
  17. 17. Rullier E, Le Toux N, Laurent C, et al. Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery[J]. World J Surg, 2001, 25(3):274-277.
  18. 18. 張洪偉, 王京華, 王為忠, 等. 低位直腸癌保肛術(shù)后吻合口漏9例的原因及治療[J]. 第四軍醫(yī)大學(xué)學(xué)報(bào), 2007, 28(12):1139-1141.
  19. 19. Miki K, Sasajima M, Ohtsuka T, et al. Pepsinogen Ⅰ, pepsinogenⅡ, and pepsinogen Ⅰ/Ⅱ ratio[J]. Nihon Rinsho, 2005, 63 Suppl.
  20. 20. Giuliano AE, Jones RC, Brennan M, et al. Sentinel lymphadenectomy in breast cancer[J]. J Clin Onco1, 1997, 15(6):2345-2350.
  21. 21. 劉新杰, 傅建民, 麥沛成. 美藍(lán)染色法檢測(cè)乳腺癌前哨淋巴結(jié)的臨床研究[J]. 臨床外科雜志, 2003, 11(3):146-148.
  22. 22. 陳玉祥, 李俊, 黃衛(wèi), 等. 腸道準(zhǔn)備與結(jié)直吻合口漏的探討[J]. 醫(yī)藥前沿, 2012, 2(13):293-294.
  23. 23. 賴百塘, 汪蕙, 湛秀萍, 等. 亞甲藍(lán)體內(nèi)抗腫瘤作用及藥理學(xué)研究[J]. 中華腫瘤雜志, 1989, 11(2):98-100.
  24. 24. Wang H, Shah V, Lanks KW. Use of oxidizing dyes in combination with 2-cyanocinnamic acid to enhance hyperthermic cytotoxicity in L929 cells[J]. Cancer Res, 1987, 47(13):3341-3343.
  25. 25. 馮樹, 曾青, 周麗娜, 等. 亞甲藍(lán)對(duì)結(jié)腸癌細(xì)胞系Lovo的殺傷和抑制作用[J]. 沈陽藥科大學(xué)學(xué)報(bào), 2000, 17(4):283-285.
  26. 26. 張巍峨, 馮明功. 亞甲藍(lán)抑制癌細(xì)胞能量代謝機(jī)制的研究[J]. 華北煤炭醫(yī)學(xué)院學(xué)報(bào), 2011, 13(3):344-345.
  27. 27. 傅士羅. 淺談亞甲藍(lán)注射液的四種應(yīng)用及機(jī)制[J]. 基層醫(yī)學(xué)論壇, 2010, 14(35):1120.
  28. 28. -98.
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