直肠上动脉亚甲蓝灌注法判断全直肠系膜切除术后标本系膜的完整性

Integrity evaluation of resected mesentery specimen after total mesorectal excision by methylene blue perfusion via superior rectal artery

目的探讨经直肠上动脉灌注亚甲蓝对低位直肠癌行全直肠系膜切除术（TME）后标本系膜完整性判断的临床意义。方法将按照TME原则进行根治性手术的20例低位直肠癌患者的切除标本．按随机数字表法分为亚甲蓝组和常规检测组．每组10例。常规检测组术后肉眼观察直肠系膜完整性情况．亚甲蓝组经直肠上动脉灌注肝素和亚甲蓝．观察有无亚甲蓝从系膜表面溢出．并进一步对亚甲蓝溢出处系膜及系膜淋巴结情况进行镜检。结果所有病例标本肉眼下观察直肠系膜均完整．亚甲蓝组经直肠上动脉灌注亚甲蓝后，直肠系膜染色明显．8例直肠系膜面无亚甲蓝溢出．提示直肠系膜完整．2例出现亚甲蓝溢出，提示系膜存在肉眼观察无法辨别的缺损，并在镜下得到证实。此外，亚甲蓝组淋巴结平均检出数目（17．3±2．4）枚，而常规检测组为（12．4±5．4）枚，两组差异有统计学意义（P=0．016）。结论结直肠外科医生应在TME术后常规对直肠系膜完整性进行细致评价，亚甲蓝灌注染色是判断系膜微小缺损的一种简便、有效的方法．并能提高淋巴结检出率。

Objective To evaluate the integrity of the resected mesentery specimen after total mesorectal excision （TME） for low rectal cancer using methylene blue perfusion via the superior rectal artery. Methods Twenty patients with low rectal cancer were randomly divided into the methylene blue group （u=10）and the control group （n=10）. All the patients received TME and macroscopic examination of the mesorectal surface was performed to evaluate the quality of the surgical specimen. The methylene blue was injected into the specimen postoperatively via superior rectal artery. Results The mesorectal surface of all the specimens was intact on macroscopic examination. However, after methylene blue perfusion, 2 specimens were found to be incomplete. The number of lymph nodes in the methylene blue group were significantly larger （17.3±2.4 vs. 12.4±5.4,P=0.016）. Conclusions Integrity evaluation of TME specimen is necessary. Methylene blue perfusion is a convenient and effective method to identify subtle incompleteness of specimen and can improve the detection of lymph node.