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袖状胃切除术时常规使用美蓝试验：为何不可？

THE ROUTINE USE OF THE METHYLENE BLUE TEST IN SLEEVE GASTRECTOMY: WHY NOT?

机构信息

Department of Surgery, Hospital de Clínicas, Federal University of Pernambuco, Recife, PE, Brazil.

Gastrointestinal Surgery Service, Esperança Hospital, Rede D'Or São Luiz, Recife, PE, Brazil.

出版信息

Arq Bras Cir Dig. 2022 Jan 5;34(3):e1612. doi: 10.1590/0102-672020210002e1612. eCollection 2022.

DOI:10.1590/0102-672020210002e1612
PMID:35019124
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8735257/
Abstract

BACKGROUND

Although considered a safe procedure, sleeve gastrectomy (SG) has a non-negligible risk of major postoperative complications related to it, with special attention to gastric leaks.

AIM

Evaluate the clinical value of the methylene blue test (MBT) in predicting the occurrence of post-SG leaks.

METHODS

Retrospective study that included 1136 patients who underwent SG with intraoperative MBT between 2012 and 2016. Sensitivity, specificity, positive predictive value (PPV) and negative predicted value (NPV) were calculated to determine the clinical correlation between the MBT and the occurrence of postoperative leaks. Staple line oversewing was performed in all patients who presented positive MBT.

RESULTS

Laparoscopic SG was performed in 97.0% of cases; open in 2.3%, and robotic in 0.7%. MBT was positive in 19 cases (1.67%). One positive MBT occurred during an open SG and the other 18 at laparoscopy. Moreover, there were nine cases (0.8%) of postoperative leaks, among which, only two presented positive MBT. MBT diagnostic value was evaluated through the calculation of sensitivity (22.0%), specificity (98.0%), PPV (11.0%) and NPV (99.0%). There were no cases of allergic reaction or any other side effect with the use of the methylene blue solution.

CONCLUSION

MBT showed high specificity and negative predictive value, thus presenting an important value to rule out the occurrence of postoperative leaks.

摘要

背景

尽管袖状胃切除术（SG）被认为是一种安全的手术，但它仍存在不可忽视的与术后主要并发症相关的风险，尤其是胃漏。

目的

评估亚甲蓝试验（MBT）在预测 SG 术后漏诊中的临床价值。

方法

回顾性研究纳入了 2012 年至 2016 年间行术中 MBT 的 1136 例 SG 患者。计算 MBT 与术后漏诊发生之间的临床相关性，得出其灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）。所有 MBT 阳性的患者均行吻合口缝线缝合。

结果

腹腔镜 SG 占 97.0%；开腹手术占 2.3%，机器人手术占 0.7%。19 例（1.67%）MBT 阳性。1 例开腹 SG 中 MBT 阳性，18 例腹腔镜 SG 中 MBT 阳性。此外，术后漏诊 9 例（0.8%），其中仅 2 例 MBT 阳性。通过计算灵敏度（22.0%）、特异性（98.0%）、PPV（11.0%）和 NPV（99.0%）评估 MBT 的诊断价值。使用亚甲蓝溶液无过敏反应或任何其他副作用。

结论

MBT 显示出较高的特异性和阴性预测值，因此对于排除术后漏诊具有重要价值。