Sujatha-Bhaskar Sarath, Jafari Mehraneh D, Stamos Michael J
University of California, Irvine School of Medicine, Orange, California.
Surg Technol Int. 2017 Jul 25;30:83-88.
Anastomotic leaks following colorectal anastomosis has substantial implications including increased morbidity, longer hospitalization, and reduced overall survival. The etiology of leaks includes patient factors, technical factors, and anastomotic perfusion. An intact anastomotic blood supply is especially crucial in the physiology of anastomotic healing. To date, no established intraoperative methods have been developed that reliably and reproducibly identify and prevent leak occurrence. Recently, fluorescent angiography (FA) with indocyanine green (ICG) has emerged as an innovative modality for intraoperative perfusion assessment. ICG-FA can be performed before or after intestinal resection or, alternatively, after creation of the anastomosis. Angiographic assessment with near-infrared camera filters allows determination of perfusion adequacy, guiding additional intestinal resection and anastomotic revision. Early clinical experiences with ICG-FA demonstrated safety and feasibility. Large, multi-center prospective trials, such as the Perfusion Assessment in Laparoscopic Left-Sided/Anterior Resection Study (PILLAR II), demonstrated ease of use with remarkably low anastomotic leak rates after ICG-FA-guided intraoperative revision. Current randomized control trials featuring utilization in ICG-FA in low anterior resection are currently underway and will further clarify the role of ICG-FA in leak identification and prevention. Apart from colorectal surgery, FA has also been successfully employed in other surgical disciplines such as plastic surgery, vascular surgery, foregut surgery, urology, and gynecology.
结直肠吻合术后的吻合口漏具有重大影响，包括发病率增加、住院时间延长和总生存率降低。漏的病因包括患者因素、技术因素和吻合口灌注。完整的吻合口血供在吻合口愈合生理过程中尤为关键。迄今为止，尚未开发出可靠且可重复的术中方法来识别和预防漏的发生。最近，使用吲哚菁绿（ICG）的荧光血管造影（FA）已成为术中灌注评估的一种创新方式。ICG-FA可在肠切除术前或术后进行，或者在吻合口形成后进行。使用近红外相机滤光片进行血管造影评估可确定灌注是否充足，指导进一步的肠切除和吻合口修复。ICG-FA的早期临床经验证明了其安全性和可行性。大型多中心前瞻性试验，如腹腔镜左侧/前切除术灌注评估研究（PILLAR II），证明了在ICG-FA引导的术中修复后使用方便，吻合口漏率极低。目前正在进行以ICG-FA用于低位前切除术为特色的随机对照试验，这将进一步阐明ICG-FA在漏的识别和预防中的作用。除了结直肠手术外，FA还已成功应用于其他外科领域，如整形外科、血管外科、前肠外科、泌尿外科和妇科。
