内镜无法切除的结直肠息肉腹腔镜手术前定位方法对比研究

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=0.053,0.918,0.21

Preoperative location of colorectal polyps in laparoscopic colectomy

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 patient