Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage
Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage
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DOI：
10.1007/s00423-010-0699-x
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发表时间：
2010-11-01
影响因子：
2.3
通讯作者：
Hoeer, Joerg J.
中科院分区：
文献类型：
--
作者：
Kudszus, Stefanie;Roesel, Christian;Hoeer, Joerg J.
目的:高达19%的结直肠切除术表现为明显的临床功能不足。吻合口灌注不足被认为是一个重要的危险因素。由于术中使用激光荧光血管造影（LFA）可以客观地观察组织灌注，因此我们通过回顾性配对分析来评估其对吻合口并发症发生率的影响。方法对2003 ~ 2008年所有结直肠癌手术中使用LFA （LFA组）的吻合口或切除缘进行术中观察。1998年至2003年间未进行LFA的结直肠癌切除术患者作为对照组。在年龄、t分期、切除和吻合类型、功能不全的造口、血液管理、紧急情况和体重指数等方面匹配了402例患者。采用Fisher和Wilcoxon检验进行统计分析。结果22例因吻合口瘘需要手术修复，其中LFA组7例（3.5%），对照组15例（7.5%）。亚组分析显示，选择性切除的翻修率为3.10% （LFA组）和7.7%（对照组）（p=0.04，翻修风险（ROR）降低60%）。在年龄大于70岁的患者中，翻修率为4.3% （LFA组），而11.9%（对照组）（p=0.04， ROR降低64%）。手工缝合吻合后的翻修率为1.2% （LFA组）和8.5%（对照组）（p=0.03， ROR降低84%）。LFA组住院时间明显缩短（Wilcoxon检验；p=0.01）。结论LFA组的绝对翻修率总体降低了4%，在择期结肠切除术患者、年龄大于70岁患者和手工缝合吻合患者的亚组分析中，翻修率显著降低。这表明LFA不仅可以显著降低结直肠手术严重并发症的发生率，而且可以缩短住院时间。
Purpose Up to 19% of all colorectal resections develop clinically apparent insufficiencies. Insufficient perfusion of the anastomosis is recognized as an important risk factor. As tissue perfusion can be objectified intraoperatively using laser fluorescence angiography (LFA), its effect on the rate of anastomotic complications was evaluated in a retrospective matched-pairs analysis.Methods Between 2003 and 2008, all anastomosis or resection margins in colorectal cancer resections were investigated intraoperatively using LFA (LFA group). Patients with colorectal cancer resections between 1998 and 2003 without LFA served as the control group. Four hundred two patients were matched for age, T-stage, type of resection and anastomosis, defunctioning stoma, administration of blood, emergency conditions, and body mass index. Statistical analysis was performed using the Fisher and the Wilcoxon tests.Results Twenty-two surgical revisions were necessary due to anastomotic leakage, seven (3.5%) in the LFA group and 15 (7.5%) in the control group. Subgroup analysis revealed that in elective resections the rate of revision was 3.10% (LFA group) and 7.7% (control group) (p=0.04, risk of revision (ROR) reduced by 60%). In patients older than 70 years, the rate of revision was 4.3% (LFA group) compared to 11.9% (control group) (p=0.04, ROR reduced by 64%). After hand-sewn anastomosis, the rate of revision was 1.2% (LFA group) and 8.5% (control group) (p=0.03, ROR reduced by 84%). Hospital stay was significantly reduced in the LFA group (Wilcoxon test; p=0.01).Conclusion There was an overall reduction in the absolute revision rate of 4% in the LFA group and a significantly reduced rate of revision in the subgroup analysis of patients undergoing elective colorectal resections, in patients older than 70 years and in patients with hand-sewn anastomosis. This demonstrates that LFA is a method that may significantly reduce not only the rate of severe complications in colorectal surgery but also the hospital length of stay.