| Objective This study was to observe the papaverine irrigation lumen of rectal carcinoma postoperative anastomotic healing of influence; For papaverine irrigation lumen prevent the happening of the anastomotic fistula after colorectal cancer resection provide theoretical basis and clinical guidance.Methods (1) Laser Doppler assessment measurements of blood flow13cases of colorectal cancer resection patients in intraoperative:colonic blood flow at the proximal site of the anastomosis was measured by laser Doppler flowmetry in13patients with cancer of the rectum while hight tie the inferior mesenteric artery (IMA),after ligation of IMA in anastomotic local spray papaverine lumen, records related to blood flow parameters:peak systolie velocity(PSV),end diastolic velocity(EDV), observe blood flow spectrum change.(2) Papaverine irrigation lumen in postoperative clinical selected121accord with a standard before colorectal resection patients, randomly divided into2groups (blank group, the experimental group)59cases of blank group, experimental group62cases.In the art of a stout silicone tube (26#) and a thin sputum suction tube (6#) are fixed together,in operation through the anus in the lumen, about3cm above the anastomotic,and this two drainage tube with the aid of pocket chassis on anus periderm skin suture fixation.Postoperative through thin tube to wash the intestine, with saline control group, the experimental group were treated with papaverine,1-2times/day for5-7days days, while in the first5-7days after the two groups were drawn peripheral venous blood, check CRP, WBC.(3)Postoperative radiographic observation anastomosis in5-7days after the X-ray diatrizoate enema observed anastomotic healing. After imaging diagnosis of anastomotic fistula underwent conservative treatment, the need to review again to confirm anastomotic healing.Results (1)The proximal colon after high ligation of IMA edge vascular arch appeared significantly reduced blood supply, the former PSV ligation (34.18±10.13) cm/s, after ligation (21.17±6.10) cm/s,(P=0.00), EDV ligation before (5.24±2.21) cm/s, after ligation (3.84±1.99) cm/s,(P=0.00); topical papaverine intestine before giving PSV (21.17±6.10) cm/s, after administration (31.70±9.82) cm/s,(P=0.00); former EDV administration (3.84±1.99) cm/s, after administration (4.82±2.04) cm/s,(P=0.00).2, all patients in the first5-7days after detection of WBC, CRP and other inflammatory markers. Blank group WBC, CRP mean respectively (8.79±0.39) x109/L,(38.35±5.99) mg/L; experimental group WBC, CRP mean respectively (8.98±0.40) x109/L,(26.13±4.65) mg/L; between the two groups showed no significant difference (P=0.76; P=0.127).10cases of patients with anastomotic leakage mean CRP (103.5±62.61) mg/L, WBC mean (10.55±3.57) x109/L, higher than in patients with normal fit.3, after the first5-7days after diatrizoate enema X-ray observation of anastomotic healing, anastomotic leakage were found in10cases, the rate was8.26%, which blank8patients (13.56%), the experimental group2cases (3.22%), there were significant differences (P=0.039) groups. Where X-ray diatrizoate enema diagnosis eight cases, the diagnosis rate of80%, while relying on the three-dimensional reconstruction of CT contrast agent intestine diagnosis in2cases. There are two cases of anastomotic leakage in patients with fever, abdominal pain;3patients had fecal residue samples or bloody drainage.All anastomotic fistula patients were cured with conservative treatment.Conclusion (1)High ligation of the IMA proximal colon after anastomotic blood supply decline, given the intestine after topical papaverine anastomotic blood supply increase;(2)WBC, CRP and other inflammatory markers, and abdominal pain, bloating for the diagnosis of anastomotic leakage indication of the value of certain, but not all patients had anastomotic leak this performance, the lack of specificity, X-ray diatrizoate enema has good clinical value for early diagnosis of anastomotic fistula;(3)Papaverine irrigation lumen can effectively prevent abdominal rectal cancer resection after the occurrence of anastomotic fistula, increase the safety and clinical popularization value. |
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