The Application of Air Leak Test Combined with Methylene Blue Solution Leak Test in Detection of Anastomotic Leakage after Total Mesorectal Excision in Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HEN Yuxiang , HUANG Wei , LI Jun , FANG Xiang , HUANG Guofei

Department of The Third General Surgery， People’s Hospital of Deyang City， Deyang 618000， Sichuan Province， China;

Corresponding author：

HEN Yuxiang, Email: huanggf11@163.com

Keywords：

Rectal cancer; Air leak test; Methylene blue solution leak test; Anastomotic leakage; Total mesorectal excision; Prevention

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Objective 　To investigate the application of air leak test combined with methylene blue solution leak test in the detection of anastomotic leakage after total mesorectal excision （TME） in rectal cancer.
Methods 　In total of132 patients with rectal cancer underwent Dixon according to TME in our hospital from Mar. 2010 to Mar. 2013 were enrolled. All patients were randomly divided into air leak test group （n=65） and air leak＋methylene blue solution leak test group （n=67）. The intestinal anastomosis of patients in air leak test group were clamped at 2 cm from the upper end
of bowel， then injecting 500 mL distilled water to pelvic， and placing 24# Foley catheter through the anus. The catheter balloon was injected with water to close anus， and then injected with 50 mL gas to find the anastomotic leakage where bubbles happened， and then repaired it. Patients of air leak＋methylene blue solution leak test group were treated with methylene blue solution test in addition. After sucking out of the distilled water in pelvic and gas in the rectum， 1 bottle of methylene blue solution （20 mg） and 50 mL saline were injected， observing the location where the methylene blue solution
leaking out and repaired it.
Results 　Three cases （4.62%） of anastomotic leakage were found during operation in air leak test group， and 9 cases （13.85%） were found after operation. Of the 9 cases， 5 cases were cured with placement of adeq-uate drainage and symptomatic treatment， 3 cases were cured with anal patch， and 1 case was cured with transverse colon fistula and drainage. In total of 15 cases （22.39%） were found anastomotic leakage， 2 cases of them were found by air leak test and another 13 cases were found by methylene blue solution leak test during operation in air leak＋methylene blue
solution leak test group， but no one suffered anastomotic leakage after operation. Compared with air test group， detection
rate of anastomotic leakage during operation was higher （P＜0.05）， and incidence rate of anastomotic leakage after opera-
tion was lower in air leak＋methylene blue solution leak test group （P＜0.05）.
Conclusions 　Large anastomotic leakage can be found by using air leak test， and small and hidden leakage can be found by using methylene blue solution leak test， combination method of the two experiments is better. Repair can be performed effectively under direct vision.

Citation： HEN Yuxiang,HUANG Wei,LI Jun,FANG Xiang,HUANG Guofei,.. The Application of Air Leak Test Combined with Methylene Blue Solution Leak Test in Detection of Anastomotic Leakage after Total Mesorectal Excision in Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(9): 1034-1037. doi: Copy

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25.	冯树，曾青，周丽娜，等. 亚甲蓝对结肠癌细胞系Lovo的杀伤和抑制作用[J]. 沈阳药科大学学报， 2000， 17(4)：283-285.
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27.	傅士罗. 浅谈亚甲蓝注射液的四种应用及机制[J]. 基层医学论坛， 2010， 14(35)：1120.
28.	-98.

1. Heald RJ， Husband EM， Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence?[J]. Br J Surg， 1982， 69(10)：613-616.
2. Heald RJ， Ryall RDH. Recurrence and survival after total mesorectal excision for rectal cancer[J]. Lancet， 1986， 327(8469)：1479-1482.
3. Heald RJ， Karanjia ND. Results of radical surgery for rectal cancer[J]. World J Surg， 1992， 16(5)：848-857.
4. Bonjer HJ， Hop WC， Nelson H， et al. Laparoscopically assisted vs. open colectomy for colon cancer：a meta-analysis[J]. Arch Surg， 2007， 142(3)：298-303.
5. 丛山，李延茂，张烈，等. 腹腔镜根治性直肠癌切除术的临床探讨[J]. 腹腔镜外科杂志， 2009， 14(3)：200-201.
6. 廖传文，曹虹，胡淑琴，等. 粗口径肛管和亚甲蓝混合液联用在预防直肠癌术后吻合口漏的临床研究[J]. 江西医药， 2010， 45(10)：961-963.
7. 卞守华，欧阳卫东. 低位直肠癌全直肠系膜切除术吻合口瘘原因及其防治[J]. 内蒙古医学杂志， 2009， 41(1)：40-42.
8. 徐忠发，左文述，刘奇. 现代肛肠肿瘤外科学[M]. 济南：山东科学技术出版社， 1993：211-222.
9. ：741-743.
10. Santin AD， Diamandis EP， Bellone S， et al. Overexpression of kallikrein 10 (hK10) in uterine serous papillary carcinomas[J]. Am J Obstet Gynecol， 2006， 194(5)：1296-1302.
11. Bellone S， Watts K， Cane’S， et al. High serum levels of interl-eukin-6 in endometrial carcinoma are associated with uterine serouspapillary histology， a highly aggressive and chemotherapy-resistantvariant of endometrial cancer[J]. Gynecol Oncol， 2005， 98(1)：.
12. Chan JK， Loizzi V， Youssef M， et al. Significance of comprehensive surgical staging in noninvasive papillary serous carcinoma of the endometrium[J]. Gynecol Oncol， 2003， 90(1)：181-185.
13. Thomas MB， Mariani A， Cliby WA， et al. Role of cytoreductionin stageⅢand Ⅳ uterine papillary serous carcinoma[J]. GynecolOncol， 2007， 107(2)：190-193.
14. Peeters KC， Tollenaar RA， Marijnen CA， et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer[J]. Br J Surg， 2005， 92(2)：211-216.
15. 戴东，颜文贞，谭小宇，等. 直肠癌低位吻合口瘘预防措施的临床探讨[J]. 中华肿瘤防治杂志， 2008， 15(23)：1832-1834.
16. 赵广法，师英强，莫善兢. 直肠全系膜切除术后吻合口漏的危险因素分析和对策[J]. 肿瘤， 2004， 24(6)：595-597.
17. Rullier E， Le Toux N， Laurent C， et al. Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery[J]. World J Surg， 2001， 25(3)：274-277.
18. 张洪伟，王京华，王为忠，等. 低位直肠癌保肛术后吻合口漏9例的原因及治疗[J]. 第四军医大学学报， 2007， 28(12)：1139-1141.
19. Miki K， Sasajima M， Ohtsuka T， et al. Pepsinogen Ⅰ， pepsinogenⅡ， and pepsinogen Ⅰ/Ⅱ ratio[J]. Nihon Rinsho， 2005， 63 Suppl.
20. Giuliano AE， Jones RC， Brennan M， et al. Sentinel lymphadenectomy in breast cancer[J]. J Clin Onco1， 1997， 15(6)：2345-2350.
21. 刘新杰，傅建民，麦沛成. 美蓝染色法检测乳腺癌前哨淋巴结的临床研究[J]. 临床外科杂志， 2003， 11(3)：146-148.
22. 陈玉祥，李俊，黄卫，等. 肠道准备与结直吻合口漏的探讨[J]. 医药前沿， 2012， 2(13)：293-294.
23. 赖百塘，汪蕙，湛秀萍，等. 亚甲蓝体内抗肿瘤作用及药理学研究[J]. 中华肿瘤杂志， 1989， 11(2)：98-100.
24. Wang H， Shah V， Lanks KW. Use of oxidizing dyes in combination with 2-cyanocinnamic acid to enhance hyperthermic cytotoxicity in L929 cells[J]. Cancer Res， 1987， 47(13)：3341-3343.
25. 冯树，曾青，周丽娜，等. 亚甲蓝对结肠癌细胞系Lovo的杀伤和抑制作用[J]. 沈阳药科大学学报， 2000， 17(4)：283-285.
26. 张巍峨，冯明功. 亚甲蓝抑制癌细胞能量代谢机制的研究[J]. 华北煤炭医学院学报， 2011， 13(3)：344-345.
27. 傅士罗. 浅谈亚甲蓝注射液的四种应用及机制[J]. 基层医学论坛， 2010， 14(35)：1120.
28. -98.

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The Application of Air Leak Test Combined with Methylene Blue Solution Leak Test in Detection of Anastomotic Leakage after Total Mesorectal Excision in Rectal Cancer

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