目的 评价内镜无法切除的结直肠息肉患者行腹腔镜手术前结肠镜检查钛夹定位、美蓝注射定位的应用效果.方法 回顾性分析2006年8月至2012年9月中山大学附属第三医院收治的31例内镜下无法切除的结直肠息肉患者的临床资料,其中腹腔镜手术前以钛夹定位者18例为钛夹组,以美蓝定位者13例为美蓝组.钛夹组:常规结肠镜检查,首先取组织行病理检查,随后在息肉上下缘组织各置入钛夹1～2枚标记,结肠镜检查结束后立即行卧位腹部X线片检查确定金属钛夹位置而判定息肉的部位.美蓝组:腹腔镜手术前24 h内清洁肠道,施行结肠镜检查,用内镜注射针刺入息肉基底旁黏膜下,推注美蓝1 mL,见黏膜鼓起一蓝色疱疹.息肉所在水平肠管的四周肠壁均以同样方法注射美蓝,共4点.如果上述两种定位方法失败,最后行术中结肠镜定位.所有患者按结直肠肿瘤治疗原则行腹腔镜肠段及相应系膜切除术,分析两组患者的定位效果和治疗情况.计量资料采用t检验,计数资料采用x2检验.结果 钛夹组患者定位成功率为15/18,美蓝组患者定位成功率为8/13,两组比较,差异无统计学意义(x2=0.284,P＞0.05).8例定位失败者均改用术中结肠镜定位,但手术时间延长至(44±13) min.31例患者均未发现定位错误.本组患者4例行腹腔镜右半结肠切除术,11例行腹腔镜左半结肠切除术,9例行腹腔镜乙状结肠切除术,7例行腹腔镜直肠前切除术.钛夹组和美蓝组患者术后均无手术并发症发生和患者死亡,标本长度、近切缘距肿瘤上缘距离、远切缘距肿瘤下缘距离(结肠息肉)、远切缘距肿瘤下缘距离(高位直肠息肉)、淋巴结清扫数目分别为(20 ±7)cm、(11 ±4)cm、(8.6 ±3.1)cm、(4.2±1.1)枚、(8±5)枚和(20±5)cm、(9 ±3)cm、(9.1±2.8)cm、(4.6±0.5)枚、(7±6)枚,两组比较,差异无统计学意(t=0.053,0.918,0.213,1.486,0.267,P＞0.05).两组患者中有15例术后病理检查结果为息肉癌变,其中TNM Ⅰ期8例、Ⅱ期6例、Ⅲ期1例.结论 对于内镜无法切除的结直肠息肉患者采用腹腔镜手术治疗,术前检查提示息肉位于降结肠以上者,钛夹标记定位法简单、安全、高效,美蓝注射定位方法简便但对操作技术要求较高,而对于降结肠以下息肉可选用术中结肠镜定位.
目的 評價內鏡無法切除的結直腸息肉患者行腹腔鏡手術前結腸鏡檢查鈦夾定位、美藍註射定位的應用效果.方法 迴顧性分析2006年8月至2012年9月中山大學附屬第三醫院收治的31例內鏡下無法切除的結直腸息肉患者的臨床資料,其中腹腔鏡手術前以鈦夾定位者18例為鈦夾組,以美藍定位者13例為美藍組.鈦夾組:常規結腸鏡檢查,首先取組織行病理檢查,隨後在息肉上下緣組織各置入鈦夾1～2枚標記,結腸鏡檢查結束後立即行臥位腹部X線片檢查確定金屬鈦夾位置而判定息肉的部位.美藍組:腹腔鏡手術前24 h內清潔腸道,施行結腸鏡檢查,用內鏡註射針刺入息肉基底徬黏膜下,推註美藍1 mL,見黏膜鼓起一藍色皰疹.息肉所在水平腸管的四週腸壁均以同樣方法註射美藍,共4點.如果上述兩種定位方法失敗,最後行術中結腸鏡定位.所有患者按結直腸腫瘤治療原則行腹腔鏡腸段及相應繫膜切除術,分析兩組患者的定位效果和治療情況.計量資料採用t檢驗,計數資料採用x2檢驗.結果 鈦夾組患者定位成功率為15/18,美藍組患者定位成功率為8/13,兩組比較,差異無統計學意義(x2=0.284,P＞0.05).8例定位失敗者均改用術中結腸鏡定位,但手術時間延長至(44±13) min.31例患者均未髮現定位錯誤.本組患者4例行腹腔鏡右半結腸切除術,11例行腹腔鏡左半結腸切除術,9例行腹腔鏡乙狀結腸切除術,7例行腹腔鏡直腸前切除術.鈦夾組和美藍組患者術後均無手術併髮癥髮生和患者死亡,標本長度、近切緣距腫瘤上緣距離、遠切緣距腫瘤下緣距離(結腸息肉)、遠切緣距腫瘤下緣距離(高位直腸息肉)、淋巴結清掃數目分彆為(20 ±7)cm、(11 ±4)cm、(8.6 ±3.1)cm、(4.2±1.1)枚、(8±5)枚和(20±5)cm、(9 ±3)cm、(9.1±2.8)cm、(4.6±0.5)枚、(7±6)枚,兩組比較,差異無統計學意(t=0.053,0.918,0.213,1.486,0.267,P＞0.05).兩組患者中有15例術後病理檢查結果為息肉癌變,其中TNM Ⅰ期8例、Ⅱ期6例、Ⅲ期1例.結論 對于內鏡無法切除的結直腸息肉患者採用腹腔鏡手術治療,術前檢查提示息肉位于降結腸以上者,鈦夾標記定位法簡單、安全、高效,美藍註射定位方法簡便但對操作技術要求較高,而對于降結腸以下息肉可選用術中結腸鏡定位.
목적 평개내경무법절제적결직장식육환자행복강경수술전결장경검사태협정위、미람주사정위적응용효과.방법 회고성분석2006년8월지2012년9월중산대학부속제삼의원수치적31례내경하무법절제적결직장식육환자적림상자료,기중복강경수술전이태협정위자18례위태협조,이미람정위자13례위미람조.태협조:상규결장경검사,수선취조직행병리검사,수후재식육상하연조직각치입태협1～2매표기,결장경검사결속후립즉행와위복부X선편검사학정금속태협위치이판정식육적부위.미람조:복강경수술전24 h내청길장도,시행결장경검사,용내경주사침자입식육기저방점막하,추주미람1 mL,견점막고기일람색포진.식육소재수평장관적사주장벽균이동양방법주사미람,공4점.여과상술량충정위방법실패,최후행술중결장경정위.소유환자안결직장종류치료원칙행복강경장단급상응계막절제술,분석량조환자적정위효과화치료정황.계량자료채용t검험,계수자료채용x2검험.결과 태협조환자정위성공솔위15/18,미람조환자정위성공솔위8/13,량조비교,차이무통계학의의(x2=0.284,P＞0.05).8례정위실패자균개용술중결장경정위,단수술시간연장지(44±13) min.31례환자균미발현정위착오.본조환자4례행복강경우반결장절제술,11례행복강경좌반결장절제술,9례행복강경을상결장절제술,7례행복강경직장전절제술.태협조화미람조환자술후균무수술병발증발생화환자사망,표본장도、근절연거종류상연거리、원절연거종류하연거리(결장식육)、원절연거종류하연거리(고위직장식육)、림파결청소수목분별위(20 ±7)cm、(11 ±4)cm、(8.6 ±3.1)cm、(4.2±1.1)매、(8±5)매화(20±5)cm、(9 ±3)cm、(9.1±2.8)cm、(4.6±0.5)매、(7±6)매,량조비교,차이무통계학의(t=0.053,0.918,0.213,1.486,0.267,P＞0.05).량조환자중유15례술후병리검사결과위식육암변,기중TNM Ⅰ기8례、Ⅱ기6례、Ⅲ기1례.결론 대우내경무법절제적결직장식육환자채용복강경수술치료,술전검사제시식육위우강결장이상자,태협표기정위법간단、안전、고효,미람주사정위방법간편단대조작기술요구교고,이대우강결장이하식육가선용술중결장경정위.
Objective To investigate the efficacies of preoperative location with titanium clip and methylene blue staining in laparoscopic colectomy.Methods The clinical data of 31 patients with colorectal polyps which could not be resected under endoscope were admitted to the Third Affiliated Hospital of Sun Yat-Sen University from August 2006 to September 2012 were retrospectively analyzed.According to the methods of preoperative location of colorectal polyps,all patients were divided into the titanium clip group (18 patients) and the methylene blue group (13 patients).Titanium clip group:enteroscopic and pathological examination were firstly performed,and then 1 or 2 titanium clips were placed at the superior and inferior part of the polyps.After enteroscopic examination,abdominal X ray examination was performed to detect the position of polyps according to the positions of the titanium clips.Methylene blue group:after colonoscopy,methylene blue of 1 mL was injected into the adjacent mucosa of the polyps,and 4 positions around the polyps were selected for the injection of methylene blue.If the 2 locating methods were failed,intraoperative enteroscopy was performed.Laparoscopic resection for intestine or mesenterium was performed according to the treatment principle of colorectal neoplasms,and the location efficacy of the 2 methods and the treatment of the 2 groups were analyzed.The measurement data and the count data were analyzed using the t test and chi-square test,respectively.Results The success rates of the titanium clip group and the methylene blue group were 15/18 and 8/13,with no significant difference between the 2 groups (x2=0.284,P ＞0.05).The polyps in 8 patients which were failed to be localized by titanium clip or methylene blue were localized by intraoperative enteroscopy,while the operation time was prolonged to (44 ± 13)minutes.No positioning errors were detected in all the 31 patients.Laparoscopic right colectomy was performed on 4 patients,laparoscopic left colectomy on 11 patients,laparoscopic sigmoid colectomy on 9 patients,laparoscopic anterior resection of rectum on 7 patients.No morbidity or mortality was detected in the 2 groups.The length of specimen,distance between the proximal margin and the superior margin of the tumor,distance between the distal margin and the inferior margin of the tumor (patients with colonic polyps),distance between the distal margin and the inferior margin of the tumor (patients with high rectal polyps),and the number of lymph node resected were (20 ± 7) cm,(11 ± 4) cm,(8.6 ± 3.1) cm,4.2 ± 1.1,8 ± 5 in the titanium clip group,and (20 ± 5) cm,(9 ± 3) cm,(9.1 ± 2.8) cm,4.6 ± 0.5,7 ± 6 in the methylene blue group,with no significant difference between the 2 groups (t =0.053,0.918,0.213,1.486,0.267,P ＞0.05).Fifteen patients had cancerization of the polyps,including 8 patients with TNM Ⅰ stage,6 with TNM Ⅱ] stage and 1 with TNM Ⅲ stage.Conclusions For patients with colorectal polyps located at the intestine above the descending colon,titanium clip locating is easy,safe and effective,and it could be the first choice for locating the colorectal polyps.Endoscopic methvlene blue staining is simple but high technique demanding.Intraoperative enteroscopy is precise for locating the polyps at the intestine below the descending colon.
