Fluorescence angiography with indocyanine green (ICG) to evaluate anastomosis in colorectal surgery: where does it have more value?
Fluorescence angiography with indocyanine green (ICG) to evaluate anastomosis in colorectal surgery: where does it have more value?
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DOI：
10.1007/s00464-019-07159-1
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发表时间：
2019-10-04
影响因子：
3.1
通讯作者：
Balla, Andrea
中科院分区：
文献类型：
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作者：
Morales-Conde, Salvador;Alarcon, Isaias;Balla, Andrea
背景：吲哚青绿(ICG)荧光血管造影术(FA)用于术中实时评估吻合口的血管供应。然而，还需要进一步的研究来评估它在结直肠手术中的优势，并知道这项技术在哪些手术中更有价值。本研究的目的是评估ICG-FA在结直肠吻合口评估中的作用，并根据ICG-FA和吻合口漏(AL)的发生率，根据切除的类型来评估最有用的部分。方法本研究为前瞻性研究。自2014年9月至2018年11月，所有在本中心接受ICG-FA结直肠手术的患者均纳入本研究。根据手术类型，将患者分为4组：A组，右半结肠切除术；B组，脾弯曲节段性切除术；C组，左半结肠切除术；D组，直肠前切除术。结果共入选192例患者，其中A组67例，B组9例，C组81例，D组35例。35例(18.2%)患者发生了ICG-FA的剖面线改变，其中A组4例(6%)，B组1例(11.1%)，C组21例(25.9%)，D组9例(25.7%)。ALS发生5例(2.6%)：A组2例(3%)，C组1例(1.2%)，D组2例(5.7%)。结论ICG-FA可使左半结肠切除后前切除术的切除范围发生明显改变。FA是一种很有前途的光学成像技术，可以减少结直肠手术后AL的发生率。为了证实这一数据，需要对更大的样本量和对吻合口灌注的客观评估进行进一步的研究。
Background Indocyanine green (ICG) fluorescence angiography (FA) was introduced to provide the real-time intraoperative evaluation of the vascular supply of anastomosis. However, further studies are required to evaluate its advantages in colorectal surgery and to know in which procedure this technology has more value. The aim of the present study is to assess the usefulness of the ICG-FA in the colorectal anastomosis evaluation and to evaluate where it is most useful depending on type of resection performed in terms of change of section line based on the ICG-FA and anastomotic leakage (AL) rates. Methods This is a prospective study. From September 2014 to November 2018, all patients who underwent any colorectal surgical procedure with ICG-FA in our center were enrolled in the study. Based on the type of surgery, patients were grouped in 4 categories: Group A, right hemicolectomy; Group B, segmental resection of the splenic flexure; Group C, left hemicolectomy; and Group D, anterior resection of the rectum. Results One-hundred-ninety-two unselected consecutive patients were enrolled: 67 in group A, 9 in B, 81 in C, and 35 in D. Change of section line based on ICG-FA occurred in 35 cases (18.2%): 4 in group A (6%), 1 in group B (11.1%), 21 in group C (25.9%), and 9 in group D (25.7%). ALs occurred in 5 patients (2.6%): 2 in group A (3%), 1 in C (1.2%), and 2 in D (5.7%). Conclusions ICG-FA leads to significantly more changes in the resection line in case of left hemicolectomy followed by anterior resection. FA is a promising optical imaging technique to reduce the AL incidence after colorectal procedures. To confirm this data, further studies with wider sample size and with an objective evaluation of the anastomotic perfusion are required.