Diana Michele, Halvax Peter, Dallemagne Bernard, Nagao Yoshihiro, Diemunsch Pierre, Charles Anne-Laure, Agnus Vincent, Soler Luc, Demartines Nicolas, Lindner Veronique, Geny Bernard, Marescaux Jacques
IHU, Minimally Invasive Image-Guided Surgical Institute, Strasbourg, France,
Surg Endosc. 2014 Nov;28(11):3108-18. doi: 10.1007/s00464-014-3592-9. Epub 2014 Jun 10.
Fluorescence-based enhanced reality (FLER) is a technique to evaluate intestinal perfusion based on the elaboration of the Indocyanine Green fluorescence signal. The aim of the study was to assess FLER's performances in evaluating perfusion in an animal model of long-lasting intestinal ischemia.
An ischemic segment was created in 18 small bowel loops in 6 pigs. After 2 h (n = 6), 4 h (n = 6), and 6 h (n = 6), loops were evaluated clinically and by FLER to delineate five regions of interest (ROIs): ischemic zone (ROI 1), presumed viable margins (ROI 2a-2b), and vascularized areas (3a-3b). Capillary lactates were measured to compare clinical vs. FLER assessment. Basal (V 0 ) and maximal (V max) mitochondrial respiration rates were determined according to FLER.
Lactates (mmol/L) at clinically identified resection lines were significantly higher when compared to those identified by FLER (2.43 ± 0.95 vs. 1.55 ± 0.33 p = 0.02) after 4 h of ischemia. Lactates at 2 h at ROI 1 were 5.45 ± 2.44 vs. 1.9 ± 0.6 (2a-2b; p < 0.0001) vs. 1.2 ± 0.3 (3a-3b; p < 0.0001). At 4 h, lactates were 4.36 ± 1.32 (ROI 1) vs. 1.83 ± 0.81 (2a-2b; p < 0.0001) vs. 1.35 ± 0.67 (3a-3b; p < 0.0001). At 6 h, lactates were 4.16 ± 2.55 vs. 1.8 ± 1.2 vs. 1.45 ± 0.83 at ROI 1 vs. 2a--2b (p = 0.013) vs. 3a-3b (p = 0.0035). Mean V 0 and V max (pmolO2/second/mg of tissue) were significantly impaired after 4 and 6 h at ROI 1 (V 0 (4h) = 34.83 ± 10.39; V max (4h) = 76.6 ± 29.09; V 0 (6h) = 44.1 ± 12.37 and V max (6h) = 116.1 ± 40.1) when compared to 2a--2b (V 0 (4h) = 67.1 ± 17.47 p = 0.00039; V max (4h) = 146.8 ± 55.47 p = 0.0054; V 0 (6h) = 63.9 ± 28.99 p = 0.03; V max (6h) = 167.2 ± 56.96 p = 0.01). V 0 and V max were significantly higher at 3a-3b.
FLER may identify the future anastomotic site even after repetitive assessments and long-standing bowel ischemia.
基于荧光的增强现实（FLER）是一种基于吲哚菁绿荧光信号处理来评估肠道灌注的技术。本研究的目的是评估FLER在评估长期肠道缺血动物模型灌注中的性能。
在6头猪的18个小肠袢中创建缺血段。在2小时（n = 6）、4小时（n = 6）和6小时（n = 6）后，对肠袢进行临床评估和FLER评估，以划定五个感兴趣区域（ROI）：缺血区（ROI 1）、假定的存活边缘（ROI 2a - 至2b）和血管化区域（3a - 至3b）。测量毛细血管乳酸水平以比较临床评估与FLER评估。根据FLER确定基础（V0）和最大（Vmax）线粒体呼吸速率。
缺血4小时后，临床确定的切除线处的乳酸（mmol/L）显著高于FLER确定的切除线处（2.43±0.95对1.55±0.33，p = 0.02）。ROI 1处2小时时的乳酸为5.45±2.44，而2a - 至2b处为1.9±0.6（p < 0.0001），3a - 至3b处为1.2±0.3（p < 0.0001）。4小时时，ROI 1处乳酸为4.36±1.32，2a - 至2b处为1.83±0.81（p < 0.0001），3a - 至3b处为1.35±0.67（p < 0.0001）。6小时时，ROI 1处乳酸为4.16±2.55，2a - 至2b处为1.8±1.2（p = 0.013），3a - 至3b处为1.45±0.83（p = 0.0035）。与2a - 至2b相比，ROI 1处4小时和6小时后的平均V0和Vmax（pmolO2/秒/毫克组织）显著受损（V0（4小时）= 34.83±10.39；Vmax（4小时）= 76.6±29.09；V0（6小时）= 44.1±12.37，Vmax（'6小时）= 116.1±40.1）（V0（4小时）= 67.1±17.47，p = 0.00039；Vmax（4小时）= 146.8±55.47，p = 0.0054；V0（6小时）= 63.9±28.99，p = 0.03；Vmax（6小时）= 167.2±56.96，p = 0.01）。3a - 至3b处的V0和Vmax显著更高。
即使经过重复评估和长期肠道缺血，FLER仍可能识别出未来的吻合部位。
