[The effect of air test and methylene blue perfusion test on detecting the quality of anastomosis during laparoscopic rectal cancer excision (Dixon)].

Objective: To investigate the feasibility and safety of air test (AT) and methylene blue perfusion test (MBPT) to detect the quality of the anastomosis in laparoscopic rectal cancer excision (Dixon), and compare the two approaches. Methods: AT is performed by filling the pelvis with saline solution and insufflating the rectum with air through a size 22 G balloon catheter (Foley). MBPT is carried out by surrounding clean sponges around anastomosis and injecting methylene blue solution into the rectum as like as AT. The balloon catheter connected manometer,ensuring the pressure in rectum can reach 40 cmH(2)O during AT and MBPT. The presence of air bubbles and overt blue-stained spillage indicated anastomotic leaks which are were resolved during surgery. All 28 patients undergoing laparoscopic rectal excision received both AT and MBPT intraoperatively in a randomized fashion. The integrity of the anastomosis, postoperative vital signs, blood examination, drainage and postoperative imaging were analyzed. Results: All 28 patients received both tests successfully with no adverse event. MBPT Level 1 was detected in 15 cases, level 2 in 8 cases, level 3 in 5 cases. No MBPT level 4 was observed. AT level 1 was detected in 22 cases, level 2 in 5 cases, level 3 in 1 cases. No AT level 4 was founded. Three cases were diagnosed with postoperative anastomotic leakage (3/28, 10.71%), of which 2 cases were Grade B [definition and grading proposed by the international study group of rectal cancer (ISREC) in 2010]. One case was Grade C. The positive rate of MBPT was superior to AT (the McNemar testing, P<0.01). Conclusions: The two intraoperative tests are both technically feasible and safe. Compared to AT, MBPT has the advantage of localizing the leak site with a higher positive accuracy, and represents a promising standardized approach for intraoperative test of the anastomosis quality. Intraoperative repair is absolutely helpful for the level 3 and 4 intraoperative tests.目的： 探讨在腹腔镜直肠癌根治术（Dixon术）中规范检测吻合口吻合质量的安全性及可行性，并对充气试验（AT）及亚甲蓝灌注试验（MBPT）进行对比观察。 方法： 2017年5月至2018年5月对28例在山东大学齐鲁医院行Dixon术患者吻合完毕后，盆腔注入生理盐水，使生理盐水没过吻合口，经22号三腔尿管注射空气入直肠内并且达到预定压力值，如有气泡冒出提示充气试验阳性；吻合口周围缠绕一层干净纱布，直肠内注射亚甲蓝溶液且达到预定压力值时，停留15 s，观察纱布及吻合口是否有蓝染。所有28例Dixon术患者均在吻合后同时接受AT及MBPT，采用随机数表法决定AT及MBPT的先后顺序。收集患者的临床资料，观察术中的吻合效果、术后生命体征、血液学检测结果、引流液情况以及术后影像学表现等。 结果： 截止到2018年5月共纳入28例直肠癌患者，均顺利完成术中AT与MBPT，无检测相关不良事件发生。MBPTⅠ级15例，Ⅱ级8例，Ⅲ级5例，无Ⅳ级病例。AT Ⅰ级22例，Ⅱ级5例，Ⅲ级1例，无Ⅳ级病例。3例患者发生术后吻合口漏（3/28，10.71%），其中2例为B级漏（2010年国际直肠癌学组吻合口漏分级），1例为C级漏，经配对四格表的χ(2)检验（McNemar检验）进行统计学分析（P<0.05），两种方法检测效果不同，MBPT阳性率优于AT。 结论： 术中实施AT与MBPT是可行的。前期研究结果提示，Ⅲ级以上AT及MBPT采用术中缝合加固的措施是安全可靠的。MBPT阳性率高于AT，可作为准确定位术中吻合口漏位置的优先选择。.