Skrovina Matej, Bencurik Vladimir, Martinek Lubomir, Machackova Maria, Bartos Jiri, Andel Petr, Stepanova Erika, Bunakova Michaela, Vomackova Katerina
Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic.
Department of Surgery, Hospital Novy Jicin, Novy Jicin, Czech Republic.
Wideochir Inne Tech Maloinwazyjne. 2020 Mar;15(1):43-48. doi: 10.5114/wiitm.2019.84851. Epub 2019 May 8.
Anastomotic leak is a very serious complication in colorectal surgery. Tissue perfusion of the anastomosis plays an integral role in its multifactorial etiology. Fluorescence angiography using indocyanine green allows visualization of perfusion in real time.
To evaluate the effectiveness of intraoperative fluorescence angiography as a tool to decrease the incidence of anastomotic leak after laparoscopic or robotic low resection of the rectum for cancer.
Intraoperative fluorescence angiography was performed sequentially in 50 patients during low rectal resection for cancer with total mesorectal excision, primary anastomosis and protective ileostomy using laparoscopic or robotic technique. The results were compared to a historical control group of 50 patients with the same procedure without the use of fluorescence angiography.
The patient sets were comparable in basic demographic and clinical parameters. Intraoperative visualization of perfusion by fluorescence angiography was achieved in all patients without unwanted side-effects. In 6 (12%) patients, the resection line was adjusted based on the fluorescence angiography. The incidence of anastomotic leak was insignificantly lower in the group with fluorescence angiography (18% vs. 10%), which led to significantly shorter hospital stay. Other postoperative complications were comparable between the two groups.
Fluorescence angiography using indocyanine green is a safe and effective method with the potential of reducing anastomotic leak during minimally invasive low resection of the rectum for cancer.
吻合口漏是结直肠手术中一种非常严重的并发症。吻合口的组织灌注在其多因素病因中起着不可或缺的作用。使用吲哚菁绿的荧光血管造影可实时显示灌注情况。
评估术中荧光血管造影作为一种工具，在腹腔镜或机器人直肠癌低位切除术后降低吻合口漏发生率的有效性。
对50例接受直肠癌低位切除、全直肠系膜切除、一期吻合及保护性回肠造口术的患者，采用腹腔镜或机器人技术，术中依次进行荧光血管造影。将结果与50例接受相同手术但未使用荧光血管造影的历史对照组进行比较。
两组患者的基本人口统计学和临床参数具有可比性。所有患者均通过荧光血管造影实现了术中灌注可视化，且无不良副作用。6例（12%）患者根据荧光血管造影调整了切除线。荧光血管造影组的吻合口漏发生率略低（18%对10%），住院时间显著缩短。两组的其他术后并发症相当。
使用吲哚菁绿的荧光血管造影是一种安全有效的方法，有可能减少微创直肠癌低位切除术中的吻合口漏。
