内镜下自体血定标术在腹腔镜结直肠手术前应用的临床研究

Application of endoscopic autologous blood as located marker in pre-operation of laparoscopic colorectal surgery

目的探讨腹腔镜结直肠手术前使用患者自体血对结直肠病灶部位进行黏膜下标记方法的可行性和安全性。方法选择20例行腹腔镜手术的早期结直肠肿瘤或息肉摘除后癌变的患者,术前用10 ml自体血在内镜下注射到病灶远、近端各2 cm大肠黏膜下。对患者的基本特点、标记后炎症指标变化及术中观察结果进行分析。结果 19例(95.00%)患者均成功实现了预期定标效果,腹腔镜下非常容易找到暗红色定标部位,仅有1例患者在术中无法明确找到定标点。所有患者在定标后第1天复查血常规、C反应蛋白均未发现白细胞、C反应蛋白等炎症指标升高,没有患者在定标后发生发热、腹痛等不适症状。结论将患者自体血注射到结直肠黏膜下来对结直肠病灶部位进行标记是一种简易、安全、有效、经济的方法,可应用于腹腔镜结直肠手术前对病灶的精确定位。

Objective To explore the feasibility and safety of endoscopic autologous blood as located marker applied in pre-operation of laparoscopic colorectal surgery. Methods Twenty patients with early stage of colorectal neoplasms or canceration after polypectomy underwent laparoscopic surgery. Before the surgery,10 ml autologous blood was injected into the distal and proximal 2 cm of the colorectal mucosa under endoscopy. The patients＇ characteristics,the inflammation markers change after marking were analyzed. Results In all of the 20 cases,19 cases（95.00%）could be easily seen the dark red marks in the serosa. Only 1 case could not found the exact location during laparoscopic operation. Moreover,none of patients found higher WBC or C-reactive protein on the next day after marking,and no clinical symptoms such as fever or abdominal pain. Conclusion Using the autologous blood to mark locations of colorectal mucosa of colorectal lesions is a simple,safe,effective and economic method. It can be used for precise localization of the lesions before laparoscopic colorectal surgery.