Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Department of Surgery, Queen Mary Hospital, Hong Kong, China.
Tech Coloproctol. 2020 Sep;24(9):935-942. doi: 10.1007/s10151-020-02232-7. Epub 2020 May 8.
Colonic perfusion is crucial for anastomotic healing and this could be evaluated intraoperatively using indocyanine-green fluorescence imaging (ICG FI). The aim of this study was to ascertain whether the use of ICG FI resulted in the reduction of anastomotic complications, i.e. AL and anastomotic stricture.
Consecutive patients who underwent anterior resections or low anterior resections at our institution in the period from January 1st 2013 to December 31st 2018 were retrospectively reviewed. Surgery performed during the period from January 1st 2013 to December 31st 2015 did not involve the use of ICG FI (ICG-) while surgery during the period from January 1st 2016 to December 31st 2018 was performed with the use of ICG FI (ICG+). The anastomotic leakage rates of the two groups were compared after propensity score matching, taking into account the height of the anastomosis and any history of pelvic irradiation.
There was a total of 258 and 317 patients who had surgery with and without ICG FI, respectively. There were 253 patients in each group after propensity score matching. The overall anastomotic leakage rate was 3.6% and 7.9% for ICG+ and ICG-, respectively, (p = 0.035). Subgroup analysis showed that the use of ICG FI was significantly associated with a lower anastomotic leakage rate in total mesorectal excision (TME), 4.7% versus 11.6%, p = 0.043, but not in non-TME resections, 3.5% versus 2.4%, (p = 0.612). ICG FI, together with sex and anastomotic height, were independent predictors of anastomotic leakage.
The routine use of ICG FI was associated with a lower anastomotic leakage rate in anterior resections. The reduction in anastomotic leakage rate was mainly seen in TME.
结肠灌洗对于吻合口愈合至关重要，这可以通过使用吲哚菁绿荧光成像（ICG FI）术中评估。本研究旨在确定是否使用 ICG FI 可减少吻合口并发症，即 AL 和吻合口狭窄。
回顾性分析 2013 年 1 月 1 日至 2018 年 12 月 31 日期间在我院行前切除术或低位前切除术的连续患者。2013 年 1 月 1 日至 2015 年 12 月 31 日期间进行的手术未使用 ICG FI（ICG-），而 2016 年 1 月 1 日至 2018 年 12 月 31 日期间进行的手术使用了 ICG FI（ICG+）。考虑到吻合口的高度和盆腔照射史，通过倾向评分匹配比较两组的吻合口漏率。
分别有 258 例和 317 例患者接受了 ICG FI 和 ICG-手术。经倾向评分匹配后，每组各有 253 例患者。总的吻合口漏率分别为 ICG+组 7.9%和 ICG-组 3.6%，（p=0.035）。亚组分析显示，在全直肠系膜切除术（TME）中，使用 ICG FI 与较低的吻合口漏率显著相关，分别为 4.7%和 11.6%，p=0.043，而非 TME 切除中则无显著相关，分别为 3.5%和 2.4%，（p=0.612）。ICG FI 与性别和吻合口高度一起是吻合口漏的独立预测因子。
常规使用 ICG FI 可降低前切除术的吻合口漏率。吻合口漏率的降低主要见于 TME。
