Lütken Christian D, Achiam Michael P, Svendsen Morten B, Boni Luigi, Nerup Nikolaj
Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark.
Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100, Copenhagen Ø, Denmark.
Surg Endosc. 2020 Dec;34(12):5223-5233. doi: 10.1007/s00464-020-07821-z. Epub 2020 Jul 21.
Compromised tissue perfusion is a significant risk factor for anastomotic leakage after intestinal resection, leading to prolonged hospitalization, risk of recurrence after oncologic resection, and reduced survival. Thus, a tool reducing the risk of leakage is highly warranted. Quantitative indocyanine green angiography (Q-ICG) is a new method that provides surgeons with an objective evaluation of tissue perfusion. In this systematic review, we aimed to determine the optimal methodology for performing Q-ICG.
A comprehensive search of the literature was performed following the PRISMA guidelines. The following databases were searched: PubMed, Embase, Scopus, and Cochrane. We included all clinical studies that performed Q-ICG to assess visceral perfusion during gastrointestinal surgery. Bias assessment was performed with the Newcastle Ottawa Scale.
A total of 1216 studies were screened, and finally, 13 studies were included. The studies found that intensity parameters (maximum intensity and relative maximum intensity) could not identify patients with anastomotic leakage. In contrast, the inflow parameters (time-to-peak, slope, and tmax) were significantly associated with anastomotic leakage. Only two studies performed intraoperative Q-ICG while the rest performed Q-ICG retrospectively based on video recordings. Studies were heterogeneous in design, Q-ICG parameters, and patient populations. No randomized studies were found, and the level of evidence was generally found to be low to moderate.
The results, while heterogenous, all seem to point in the same direction. Fluorescence intensity parameters are unstable and do not reflect clinical endpoints. Instead, inflow parameters are resilient in a clinical setting and superior at reflecting clinical endpoints.
组织灌注受损是肠道切除术后吻合口漏的一个重要危险因素，会导致住院时间延长、肿瘤切除术后复发风险增加以及生存率降低。因此，非常需要一种能降低漏出风险的工具。定量吲哚菁绿血管造影（Q-ICG）是一种为外科医生提供组织灌注客观评估的新方法。在本系统评价中，我们旨在确定进行Q-ICG的最佳方法。
按照PRISMA指南对文献进行全面检索。检索了以下数据库：PubMed、Embase、Scopus和Cochrane。我们纳入了所有在胃肠手术期间进行Q-ICG以评估内脏灌注的临床研究。采用纽卡斯尔渥太华量表进行偏倚评估。
共筛选出1216项研究，最终纳入13项研究。这些研究发现，强度参数（最大强度和相对最大强度）无法识别吻合口漏患者。相比之下，血流参数（达峰时间、斜率和tmax）与吻合口漏显著相关。只有两项研究进行了术中Q-ICG，其余研究基于视频记录进行回顾性Q-ICG。研究在设计、Q-ICG参数和患者人群方面存在异质性。未发现随机研究，证据水平总体为低到中等。
结果虽然存在异质性，但似乎都指向同一方向。荧光强度参数不稳定，不能反映临床终点。相反，血流参数在临床环境中具有弹性，在反映临床终点方面更具优势。
