Bergman R T, Gloviczki P, Welch T J, Naessens J M, Bower T C, Hallett J W, Pairolero P C, Cherry K J
Department of Diagnostic Radiology, Mayo Clinic and Foundation, Rochester, Minnesota 55905.
Ann Vasc Surg. 1992 Jan;6(1):74-9. doi: 10.1007/BF02000672.
Intravenous fluorescein is an accurate predictor of small bowel viability, but its effectiveness in assessing colon perfusion during aortic surgery has not been evaluated. Over a 10 year period 186 of 3,306 patients undergoing aortic reconstruction received 500 to 1000 mg of intravenous fluorescein intraoperatively to evaluate colon viability. Prior history of colectomy, hypogastric or mesenteric arterial occlusive disease, or ruptured aneurysm placed these patients at risk to develop ischemic colitis. Patients were operated on for aneurysmal disease (n = 94), occlusive disease (n = 66), or a combination of both (n = 26): 171 exhibited uniform normal perfusion patterns under Wood's lamp illumination, while in 11 it was "patchy." None of these patients developed full-thickness ischemic colitis (observed specificity: 100%). Fluorescence of the rectosigmoid was absent in four patients. One of these patients with a ruptured aneurysm underwent immediate sigmoid resection, while three underwent inferior mesenteric artery reimplantation. The fluorescein pattern subsequently normalized in two patients, but one underwent sigmoid resection for an expanding mesenteric hematoma. The second patient recovered without complications. The final patient continued to show a segmental sigmoid defect and postoperatively developed full-thickness injury requiring sigmoidectomy. During the same period 18 other patients developed transmural colon ischemia from 3,120 aortic reconstructions (0.6%), with a mortality rate of 56%. None had received intraoperative fluorescein. Selective use of intravenous fluorescein may reduce the mortality of ischemic colitis following aortic reconstruction.
静脉注射荧光素是小肠活力的准确预测指标，但尚未评估其在主动脉手术中评估结肠灌注的有效性。在10年期间，3306例接受主动脉重建的患者中有186例在术中接受了500至1000毫克静脉注射荧光素以评估结肠活力。既往有结肠切除术、腹下或肠系膜动脉闭塞性疾病或动脉瘤破裂病史使这些患者有发生缺血性结肠炎的风险。患者接受动脉瘤疾病（n = 94）、闭塞性疾病（n = 66）或两者合并（n = 26）的手术治疗：171例在伍德灯下显示均匀正常灌注模式，而11例为“斑片状”。这些患者均未发生全层缺血性结肠炎（观察到的特异性：100%）。4例患者直肠乙状结肠无荧光。其中1例动脉瘤破裂患者立即接受乙状结肠切除术，3例接受肠系膜下动脉再植术。2例患者的荧光模式随后恢复正常，但1例因肠系膜血肿扩大接受乙状结肠切除术。第二例患者康复无并发症。最后1例患者持续显示节段性乙状结肠缺损，术后发生全层损伤，需要行乙状结肠切除术。同期，在3120例主动脉重建手术中有18例患者发生透壁性结肠缺血（0.6%），死亡率为56%。均未接受术中荧光素注射。选择性使用静脉注射荧光素可能降低主动脉重建术后缺血性结肠炎的死亡率。
