经肠镜黏膜下注射印度墨在腹腔镜手术病灶定位中的应用

Application of colonoscopic tattooing with India ink for localization of colorectal lesions in laparoscopic surgery

目的探讨经结肠镜黏膜下注射印度墨用于结直肠肿瘤腹腔镜手术中定位的操作方法和临床效果。方法回顾性分析2015年1月-2017年11月在该院行经肠镜黏膜下注射印度墨定位术并随后行腹腔镜手术的结直肠肿瘤患者146例,采用黏膜下注射1.0 ml生理盐水形成丘样隆起后,再依次注入0.2 ml印度墨及1.0 ml生理盐水的方法进行染色定位;对操作时间、操作成功率以及有无并发症进行评估,腹腔镜手术中探查染色定位效果、有无墨汁泄漏,术后病理评估切除标本的切缘情况。结果 146例患者均在肠镜下顺利完成印度墨标记,所有患者均无出血、穿孔和发热等并发症。腹腔镜术中探查均肉眼下清晰可见印度墨染色部位,未见墨汁弥散、泄漏污染术野的情况。术后病理证实标本切缘均呈肿瘤阴性。结论经肠镜黏膜下注射印度墨是比较理想的腹腔镜手术病灶定位方法,两步法注射生理盐水2.0 ml、1∶10印度墨0.2 ml的方式可以达到既保证安全又染色清晰的效果,其操作简单、效果安全且经济性高,是适合临床上广泛应用的可靠技术。

Objective To investigate the use of submucosal injection of India ink for localization of colorectal lesions in laparoscopic surgery, and to evaluate its efficiency and safety. Methods A retrospective study of 146 patients with colorectal lesions from January 2015 to November 2017, who underwent preoperative colonoscopic marking with India ink and subsequently received laparoscopic colectomy was conducted. 1.0 ml of physiologic saline solution was first injected into the submucosa to produce an artificial submucosal elevation, and then 0.2 ml of 1 ： 10 diluted India ink followed with another 1 ml of physiologic saline solution was injected. Operation time, success rate, complications, location efficiency, and postoperative pathology were evaluated. Results The India ink tattooing was easily applied for all patients without complication. At laparoscopic surgery, all lesions could be clearly visualized. No ink diffusion, leakage, and local inflammatory responses were observed. The surgical margins of all samples were tumor negative. Conclusion Preoperative submucosal tattooing with India ink is recommended as an easy, safe and economical procedure.