亚甲蓝灌注试验与充气试验在腹腔镜直肠癌根治术吻合口质量检测中比较研究

Comparative study of methylene blue leak test and air leak test in anastomosis quality evaluation of laparoscopic radical re-section for rectal cancer

目的比较亚甲蓝灌注试验(MBLT)和充气试验(ALT)在腹腔镜直肠癌根治术吻合口质量检测中的应用效果。方法回顾性分析自2020年1月至2022年12月于北部战区总医院普通外科行腹腔镜根治性直肠前切除术的464例直肠癌患者的临床资料。所有患者在吻合完毕后均进行MBLT及ALT。向肠腔内注射亚甲蓝溶液,使压力依次达到20、25、30、35、40 cmH_(2)O,若吻合口周围组织或纱布蓝染,提示MBLT阳性并停止试验;将吻合口浸入生理盐水,向肠腔内注射空气使压力依次达到20、25、30、35、40 cmH_(2)O,若吻合口周围有气泡冒出,提示ALT阳性并停止试验。收集患者的临床资料,观察不同压力下两种检测方法的阳性率。结果肠腔内压力为20、25、30、35 cmH_(2)O时,两种检测方法阳性率比较,差异无统计学意义(P>0.05)。肠腔内压力为40 cmH_(2)O时,MBLT检测阳性率为4.53%(21/464),高于ALT检测的2.16%(10/464),差异有统计学意义(P<0.05)。ALT或MBLT阳性患者术后吻合口瘘发生率为9.52%(2/21),与ALT和MBLT均阴性患者的1.58%(7/443)比较,差异无统计学意义(P>0.05)。结论MBLT在腹腔镜直肠癌根治术吻合口质量检测中作用优于ALT,MBLT的最佳压力值为40 cmH_(2)O,ALT的最佳压力值为30 cmH_(2)O。

Objective To compare the effect of methylene blue leak test(MBLT)and air leak test(ALT)on the quality of anastomosis in laparoscopic radical resection of rectal cancer.Methods A retrospective analysis was performed on the clinical data of 464 patients with rectal cancer who underwent laparoscopic radical anterior rectal resection in the Department of General Surgery of General Hospital of Northern Theater Command from January 2020 to December 2022.All patients received MBLT and ALT after anastomosis,and injected methylene blue solution into the intestinal cavity to make the pressure reach 20,25,30,35,40 cmH_(2)O successively.If the tissue around the anastomosis or gauze blue staining,it indicated that the MBLT was positive and the injection solution was stopped.Inject air into the intestinal cavity to make the pressure reach 20,25,30,35 and 40 cmH_(2)O successively.If bubbles emerge around the anastomosis,it indicates that ALT was positive and air injection should be stopped.Clinical data of patients were collected to observe the positive rate of the two methods under different pressures.Results There was no significant difference in the positive rate between the two methods when the pressure was 20,25,30 and 35 cmH_(2)O(P>0.05).When the intracavitary pressure was 40 cmH_(2)O,the positive rate of MBLT detection was 4.53%(21/464),higher than that of ALT detection(2.16%,10/464),the difference was statistically significant(P<0.05).The incidence of postoperative anastomotic fistula in ALT or MBLT positive patients was 9.52(2/21),compared with 1.58%(7/443)in ALT and MBLT negative patients,there was no statistical significance(P>0.05).ConclusioMn BLT is superior to ALT in the quality detection of anastomosis during laparoscopic radical resection of rectal cancer.The optimal pressure value of MBLT is 40 cmH_(2)O,and the optimal pressure value of ALT is 30 cmH_(2)O.