USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
BJU Int. 2019 Aug;124(2):302-307. doi: 10.1111/bju.14733. Epub 2019 Apr 11.
To evaluate the impact of indocyanine green (ICG) for assessing ureteric vascularity on the rate of uretero-enteric stricture formation after robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD).
We identified 179 patients undergoing RARC and ICUD between January 2014 and May 2017, and divided the patients into two groups based on the utilisation of ICG for the assessment of ureteric vascularity (non-ICG group and ICG group). We retrospectively reviewed the medical records to identify the length of ureter excised. Demographic, perioperative outcomes (including 90-day complications and readmissions), and the rate of uretero-enteric stricture were compared between the two groups. The two groups were compared using the t-test for continuous variables and the chi-squared test for categorical variables. A P < 0.05 was considered statistically significant.
A total of 132 and 47 patients were in the non-ICG group and the ICG group, respectively. There were no differences in baseline characteristics and perioperative outcomes including operating time, estimated blood loss, and length of stay. The ICG group was associated with a greater length of ureter being excised during the uretero-enteric anastomosis and a greater proportion of patients having long segment (>5 cm) ureteric resection. The median follow-up was 14 and 12 months in the non-ICG and ICG groups, respectively. The ICG group was associated with no uretero-enteric strictures compared to a per-patient stricture rate of 10.6% and a per-ureter stricture rate of 6.6% in the non-ICG group (P = 0.020 and P = 0.013, respectively).
The use of ICG fluorescence to assess distal ureteric vascularity during RARC and ICUD may reduce the risk of ischaemic uretero-enteric strictures. The technique is simple, safe, and reproducible. Larger studies with longer follow-up are needed to confirm our findings.
评估吲哚菁绿（ICG）评估输尿管血管生成对机器人辅助根治性膀胱切除术（RARC）联合腔内尿路分流（ICUD）后输尿管-肠吻合口狭窄形成率的影响。
我们回顾性分析了 2014 年 1 月至 2017 年 5 月期间 179 例接受 RARC 和 ICUD 的患者，并根据 ICG 在输尿管血管评估中的应用情况（非 ICG 组和 ICG 组）将患者分为两组。我们回顾性分析了病历，以确定切除的输尿管长度。比较两组间围手术期结果（包括 90 天并发症和再入院）和输尿管-肠吻合口狭窄发生率。两组间连续变量采用 t 检验，分类变量采用卡方检验。P 值＜0.05 为统计学差异有意义。
非 ICG 组和 ICG 组分别有 132 例和 47 例患者。两组患者的基线特征和围手术期结果（包括手术时间、估计出血量和住院时间）无差异。ICG 组在输尿管-肠吻合时切除的输尿管长度更长，且有更长段（＞5cm）输尿管切除的患者比例更高。非 ICG 组和 ICG 组的中位随访时间分别为 14 个月和 12 个月。ICG 组无一例输尿管-肠吻合口狭窄，而非 ICG 组的吻合口狭窄发生率为 10.6%（每例患者）和输尿管狭窄发生率为 6.6%（每根输尿管）（P=0.020 和 P=0.013）。
在 RARC 和 ICUD 中使用 ICG 荧光评估远端输尿管血管生成可能降低缺血性输尿管-肠吻合口狭窄的风险。该技术简单、安全且可重复。需要更大规模、更长随访时间的研究来证实我们的发现。
