自体血标记定位法在腹腔镜结直肠手术中的应用效果

Application of autologous blood labeling in laparoscopic colorectal surgery

目的评价术前经肠镜浆膜下自体血标记定位法在腹腔镜结直肠手术中的应用效果。方法对60例需行腹腔镜结直肠癌根治术的患者进行前瞻性研究。术前1 d行肠镜检查,在肿瘤下缘0.5 cm处行浆膜下四点法自体血标记肿瘤定位,术中观察寻找标记位置,术后剖视标本确认定位是否准确,对操作时间、操作成功率以及有无并发症进行评估,术后病理评估切除标本的切缘情况。结果成功在58例患者中确定了自体血标记部位,顺利完成了腹腔镜结直肠癌根治术,成功率96.7%,所有患者均无出血、穿孔和发热等并发症;2例未找到标记点,行术中肠镜定位后成功手术。手术过程均顺利。术后剖视标本,60例患者均显示定位准确,其中2例患者肿瘤位于脾曲,标记在背侧显示,腹侧无标记,导致术中无法辨认,标本病理回报显示切缘均阴性。结论经肠镜浆膜下自体血标记为腹腔镜结直肠手术前定位提供了一种安全简便、经济有效的方法,可以成为新的替代方法。

Objective To evaluate the effect of preoperative autologous blood labeling in laparoscopic colorectal surgery.Methods A prospective study was conducted in 60 patients who needed laparoscopic radical resection of colorectal cancer.Enteroscopy was performed one day before operation,and autologous blood marking was performed at 0.5 cm of the lower margin of the tumor.The location of the marker was observed during the operation.Postoperative anatomical specimens to confirm the accuracy of localization.The operation time,success rate and complications were evaluated.The incision margin of the resected specimens was evaluated by pathology after the operation.Results In laparoscopic surgery,autologous blood markers were successfully identified in 58 patients,and laparoscopic radical resection of colorectal cancer was successfully completed.The success rate was 96.7%.There were no complications such as bleeding,perforation and fever in all patients.Two patients failed to find the marker points during the operation,and were successfully operated after endoscopy positioning.Surgical procedure was smooth.Postoperative anatomical specimens,all these 60 patients showed accurate location.Two patients had tumors located in splenic curvature.The label was displayed on the dorsal side and no label on the ventral side,which led to unrecognizability during operation.Pathological returns of the specimens showed negative margins.Conclusion Subserous autologous blood labeling under enteroscopy provides a safe,simple,economical and effective method for preoperative localization of laparoscopic colorectal surgery,and can become a new alternative method.