ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery
ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery
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DOI：
10.1007/s00464-017-5475-3
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发表时间：
2017-10-01
影响因子：
3.1
通讯作者：
Sakai, Yoshiharu
中科院分区：
文献类型：
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作者：
Wada, Toshiaki;Kawada, Kenji;Sakai, Yoshiharu
荧光技术与吲哚菁绿色（ICG）提供了一个实时评估肠道灌注。然而，基于外科医生的视觉判断的荧光强度的主观评价是主要的限制。本研究评价了ICG荧光成像在腹腔镜结直肠手术中确定近端结肠横断线的定量评估，这是对112例接受腹腔镜手术治疗左侧结直肠癌患者的前瞻性数据库的回顾性分析。在远端横断肠后，体外提取标本，然后基于ICG荧光成像在灌注良好的区域内分割近端结肠。通过计算F（max）、T（max）、T（1/2）和斜率（Slope），评价ICG定量评价肠灌注对术后预后的预测价值。基于荧光成像，手术团队选择在18例病例（16.1%）中进一步近端改变横断线，直至达到“足够”的荧光部分。在18例患者中，4例（4/18：22.2%）发生AL，而在灌注良好且不需要近端改变横断线的患者中，仅1例（1/94：1.0%）发生AL。AL组5例（5/5）F（max）均小于52.0，而非AL组仅8例（8/107）F（max）小于52.0，以F（max）52.0为界值，预测AL的敏感性和特异性分别为100%和92.5%。术后肠蠕动恢复方面，早期排气组或早期排便组的T（max）分别显著低于晚期排气组或晚期排便组，ICG荧光成像可用于评估结直肠手术中的吻合口灌注，这可以导致更精确的针对个体患者的手术决策。
Fluorescence technology with indocyanine green (ICG) provides a real-time assessment of intestinal perfusion. However, a subjective evaluation of fluorescence intensity based on the surgeon's visual judgement is a major limitation. This study evaluated the quantitative assessment of ICG fluorescence imaging in determining the transection line of the proximal colon during laparoscopic colorectal surgery.This is a retrospective analysis of a prospectively maintained database of 112 patients who underwent laparoscopic surgery for left-sided colorectal cancers. After distal transection of the bowel, the specimen was extracted extracorporeally and then the proximal colon was divided within the well-perfused area based on the ICG fluorescence imaging. We evaluated whether quantitative assessment of intestinal perfusion by measuring ICG intensity could predict postoperative outcomes: F (max), T (max), T (1/2,) and Slope were calculated.Anastomotic leakage (AL) occurred in 5 cases (4.5%). Based on the fluorescence imaging, the surgical team opted for further proximal change of the transection line up to an "adequate" fluorescent portion in 18 cases (16.1%). Among the 18 patients, AL occurred in 4 patients (4/18: 22.2%), whereas it occurred in only 1 case (1/94: 1.0%) in the good perfusion patients who did not need proximal change of the transection line. The F (max) of the AL group was less than 52.0 in all 5 cases (5/5), whereas that of the non-AL group was in only 8 cases (8/107): with an F (max) cutoff value of 52.0, the sensitivity and specificity for the prediction of AL were 100 and 92.5%, respectively. Regarding postoperative bowel movement recovery, the T (max) of the early flatus group or early defecation group was significantly lower than that of the late flatus group or late defecation group, respectively.ICG fluorescence imaging is useful for assessing anastomotic perfusion in colorectal surgery, which can result in more precise operative decisions tailored for an individual patient.