Jansen-Winkeln B, Maktabi M, Takoh J P, Rabe S M, Barberio M, Köhler H, Neumuth T, Melzer A, Chalopin C, Gockel I
Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Deutschland.
Chirurg. 2018 Sep;89(9):717-725. doi: 10.1007/s00104-018-0633-2.
Anastomotic insufficiency (AI) remains the most feared surgical complication in gastrointestinal surgery, which is closely associated with a prolonged inpatient hospital stay and significant postoperative mortality. Hyperspectral imaging (HSI) is a relatively new medical imaging procedure which has proven to be promising in tissue identification as well as in the analysis of tissue oxygenation and water content. Until now, no data exist on the in vivo HSI analysis of gastrointestinal anastomoses.
Intraoperative images were obtained using the TIVITA™ tissue system HSI camera from Diaspective Vision GmbH (Pepelow, Germany). In 47 patients who underwent gastrointestinal surgery with esophageal, gastric, pancreatic, small bowel or colorectal anastomoses, 97 assessable recordings were generated. Parameters obtained at the sites of the anastomoses included tissue oxygenation (StO), the tissue hemoglobin index (THI), near-infrared (NIR) perfusion index, and tissue water index (TWI).
Obtaining and analyzing the intraoperative images with this non-invasive imaging system proved practicable and delivered good results on a consistent basis. A NIR gradient along and across the anastomosis was observed and, furthermore, analysis of the tissue water and oxygenation content showed specific changes at the site of anastomosis.
The HSI method provides a non-contact, non-invasive, intraoperative imaging procedure without the use of a contrast medium, which enables a real-time analysis of physiological anastomotic parameters, which may contribute to determine the "ideal" anastomotic region. In light of this, the establishment of this methodology in the field of visceral surgery, enabling the generation of normal or cut off values for different gastrointestinal anastomotic types, is an obvious necessity.
吻合口漏（AI）仍然是胃肠外科手术中最令人担忧的手术并发症，它与住院时间延长和术后高死亡率密切相关。高光谱成像（HSI）是一种相对较新的医学成像技术，已被证明在组织识别以及组织氧合和含水量分析方面具有广阔前景。到目前为止，尚无关于胃肠吻合口的体内HSI分析数据。
使用德国迪亚斯佩克特视觉有限公司（Pepelow，德国）的TIVITA™组织系统HSI相机获取术中图像。在47例行食管、胃、胰腺、小肠或结肠吻合的胃肠手术患者中，共产生了97份可评估记录。在吻合口部位获得的参数包括组织氧合（StO）、组织血红蛋白指数（THI）、近红外（NIR）灌注指数和组织水指数（TWI）。
使用这种非侵入性成像系统获取和分析术中图像被证明是可行的，并且在一致的基础上取得了良好的结果。观察到沿吻合口及横跨吻合口的近红外梯度，此外，对组织水和氧合含量的分析显示吻合口部位有特定变化。
HSI方法提供了一种无需使用造影剂的非接触、非侵入性术中成像程序，能够实时分析生理吻合参数，这可能有助于确定“理想”的吻合区域。鉴于此，在内脏外科领域建立这种方法，为不同类型的胃肠吻合生成正常或临界值显然是必要的。
