经肠镜肿瘤下缘注射自体血在腹腔镜手术病灶定位中的应用

Application of colonoscopic tattooing with autologous blood for localization of colorectal lesions in laparoscopic surgery

回顾性分析2019年1—12月在宁波大学医学院附属医院肛肠外科经肠镜肿瘤下缘注射自体血定位病灶后行腹腔镜手术治疗的13例结直肠肿瘤患者临床资料。其中男性8例、女性5例,年龄56~78岁;高位直肠2例、乙状结肠6例、降结肠3例、升结肠2例;5例为术前肠镜下息肉切除后病理检查示高级别瘤变或癌变行补救性腹腔镜根治术。均在结肠镜下于肿瘤下缘及正对侧位各注射5.0 ml自体血行肿瘤染色定位,染色后15~40 h行腹腔镜肿瘤切除术。13例患者均在肠镜下顺利完成自体血肿瘤染色标记,无出血、穿孔、局部感染、血栓等并发症发生。腹腔镜术中,12例肉眼下清晰可见自体血染色部位,可见局部不凝血,无广泛弥散影响手术视野的情况;1例体重指数27.2 kg/m2直肠肿瘤患者肿瘤位于腹膜返折下方,术中识别不清。术后病理检查证实标本切缘均呈肿瘤阴性。提示经肠镜肿瘤下缘注射自体血较清晰显示病灶位置,操作简单,无明显不良反应。

Thirteen patients with colorectal lesions underwent laparoscopic surgery from January to December 2019.Before surgery,5.0 ml autogenous blood was injected under colonoscopy into the inferior margin and opposite sides of the lesion for localization.The operation time,success rate,complications,location efficiency and postoperative pathology were evaluated.The autologous blood tattooing was easily applied for all patients without complication.At laparoscopic surgery,the lesions of all patients were clearly visualized except one obese patients with rectal tumors,because the tumor was located below the retroperitoneal fold.No blood diffusion and leakage,and local inflammatory responses were observed.The surgical margins of all samples were tumor negative.Preoperative tattooing with autologous blood is recommended as an easy,safe and economical procedure for colonoscopic surgery in patients with colorectal lesions.