Kim Jin Cheon, Lee Jong Lyul, Park Seong Ho
1 Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea 2 Institute of Innovative Cancer Research, Asan Medical Center, Seoul, Korea 3 Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
Dis Colon Rectum. 2017 Apr;60(4):376-384. doi: 10.1097/DCR.0000000000000782.
Since the introduction of indocyanine green angiography more than 25 years ago, few studies have presented interpretative guidelines for indocyanine green fluorescent imaging.
We aimed to provide interpretative guidelines for indocyanine green fluorescent imaging through quantitative analysis and to suggest possible indications for indocyanine green fluorescent imaging during robot-assisted sphincter-saving operations.
This is a retrospective observational study.
This study was conducted at a single center.
A cohort of 657 patients with rectal cancer who consecutively underwent curative robot-assisted sphincter-saving operations was enrolled between 2010 and 2016, including 310 patients with indocyanine green imaging (indocyanine green fluorescent imaging+ group) and 347 patients without indocyanine green imaging (indocyanine green fluorescent imaging- group).
We tried to quantitatively define the indocyanine green fluorescent imaging findings based on perfusion (mesocolic and colic) time and perfusion intensity (5 grades) to provide probable indications.
The anastomotic leakage rate was significantly lower in the indocyanine green fluorescent imaging+ group than in the indocyanine green fluorescent imaging- group (0.6% vs 5.2%) (OR, 0.123; 95% CI, 0.028-0.544; p = 0.006). Anastomotic stricture was closely correlated with anastomotic leakage (p = 0.002) and a short descending mesocolon (p = 0.003). Delayed perfusion (>60 s) and low perfusion intensity (1-2) were more frequently detected in patients with anastomotic stricture and marginal artery defects than in those without these factors (p ≤ 0.001). In addition, perfusion times greater than the mean were more frequently observed in patients aged >58 years, whereas low perfusion intensity was seen more in patients with short descending mesocolon and high ASA classes (≥3).
The 300 patients in the indocyanine green fluorescent imaging- group underwent operations 3 years before indocyanine green fluorescent imaging.
Quantitative analysis of indocyanine green fluorescent imaging may help prevent anastomotic complications during robot-assisted sphincter-saving operations, and may be of particular value in high-class ASA patients, older patients, and patients with a short descending mesocolon.
自25年前引入吲哚菁绿血管造影术以来，很少有研究提出吲哚菁绿荧光成像的解读指南。
我们旨在通过定量分析为吲哚菁绿荧光成像提供解读指南，并提出在机器人辅助保肛手术中吲哚菁绿荧光成像的可能适应证。
这是一项回顾性观察研究。
本研究在单一中心进行。
2010年至2016年期间，连续纳入657例行根治性机器人辅助保肛手术的直肠癌患者，其中310例患者进行了吲哚菁绿成像（吲哚菁绿荧光成像阳性组），347例患者未进行吲哚菁绿成像（吲哚菁绿荧光成像阴性组）。
我们试图根据灌注（结肠系膜和结肠）时间和灌注强度（5级）对吲哚菁绿荧光成像结果进行定量定义，以提供可能的适应证。
吲哚菁绿荧光成像阳性组的吻合口漏发生率显著低于吲哚菁绿荧光成像阴性组（0.6%对5.2%）（OR，0.123；95%CI，0.028 - 0.544；p = 0.006）。吻合口狭窄与吻合口漏（p = 0.002）和降结肠系膜短（p = 0.003）密切相关。与无这些因素的患者相比，吻合口狭窄和边缘动脉缺损患者更常检测到延迟灌注（>60秒）和低灌注强度（1 - 2级）（p≤0.001）。此外，年龄>58岁的患者更常观察到灌注时间大于平均值，而降结肠系膜短和美国麻醉医师协会分级高（≥3级）的患者更常出现低灌注强度。
吲哚菁绿荧光成像阴性组的300例患者在吲哚菁绿荧光成像前3年接受了手术。
吲哚菁绿荧光成像的定量分析可能有助于预防机器人辅助保肛手术中的吻合口并发症，并且在高美国麻醉医师协会分级患者、老年患者和降结肠系膜短的患者中可能具有特别价值。
