摘要
目的:探讨腹腔镜结直肠手术肿瘤的定位方法。方法:2009年12月至2013年12月收治58例结直肠肿瘤患者,其中22例于术前2 h内行亚甲蓝定位,12例术前行钛夹定位,4例术前行气钡双对比造影检查,20例术中结肠镜定位。准确定位后行腹腔镜结直肠癌根治术或局部肠段切除术。结果:2例行术前亚甲蓝标记患者因腹腔面肠壁浆膜无亚甲蓝染色而无法定位,术中行结肠镜检查定位;1例行术前钛夹定位患者腹部平片见钛夹位于右下腹,结合肠镜肿瘤距肛门的距离,确定病变位于乙状结肠;1例行术中结肠镜检查准确定位患者因结肠镜检查致使小肠及结肠胀气,无手术空间,中转开腹;4例患者行气钡双对比检查准确定位。结论:腹腔镜结直肠术中可结合直肠指诊对肿瘤进行定位,直肠指诊不能触及的肿物,通过术前行亚甲蓝、钛夹标记、气钡双对比造影及术中肠镜检查对结直肠肿瘤进行定位,术中可准确、快速定位病灶,缩短手术时间,减少并发症的发生,同时避免误切肠管及保肛失败。
Objective： To investigate the methods of tumor location in laparoscopic colorectal surgery. Methods： A retrospective analysis was performed to review the clinical data of 58 patients who underwent laparoscopic colorectal operations from Dec. 2009 to Dec. 2013. Four methods of tumor localization were used,including 22 cases of methylene blue within 2 h before operation,12 of metal clips,4 pneumobarium double contrast examination and 20 of intraoperative colonoscopy. After accurate location,laparoscopic radical operation for colorectal cancer or local intestinal segment resection was performed. Results： In methylene blue group,intraoperative colonoscopy was performed in two cases because of the inability to visualize blue dye on the serosal surface of the intestinal wall. One case of metal clips localization group was located in the right lower abdomen according to the mental clips on X ray,finally the tumor was located in the sigmoid colon by the length of the tumor from the anus in colonoscopy. One case of colonoscopy localization group was converted to open surgery because of poor operative exposure due to obvious bowel distension after colonoscopy. In pneumobarium double contrast examination group,all the tumors were found quickly during operation. Conclusions： There is a considerable rate of inaccuracy for localization in colorectal tumor by colonoscopy. In the colorectal operation,the tumor can be located by the digital rectal examination. The tumor which cannot be touched by digital rectal examination could be located by methylene blue,metal clips,pneumobarium double contrast and intraoperative colonoscopy,these methods can precisely and quickly find the tumor during operation,shorten operative time,decrease complications,avoid incorrect excision of intestine and failure of anal preservation.
出处
《腹腔镜外科杂志》
2015年第3期171-174,共4页
Journal of Laparoscopic Surgery
