吲哚菁绿荧光血管造影降低结直肠吻合口漏的风险：系统评价和荟萃分析。
Indocyanine green fluorescence angiography decreases the risk of colorectal anastomotic leakage: Systematic review and meta-analysis.
机构信息
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore.
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore.
出版信息
Surgery. 2020 Dec;168(6):1128-1137. doi: 10.1016/j.surg.2020.08.024. Epub 2020 Oct 1.
BACKGROUND
Anastomotic leakage after a colorectal resection results in devastating consequences for patients. Indocyanine green fluorescence angiography is a modality to visualize vascular perfusion at the anastomotic site and can help surgeons decide the viability of the anastomosis. We performed this systematic review and meta-analysis to evaluate the efficacy of indocyanine green fluorescence angiography in decreasing anastomotic leakage.
METHODS
PubMed, Web of Science, Embase, and the Cochrane Library were searched to identify studies comparing the use of indocyanine green fluorescence angiography versus standard care on rates of anastomotic leakage. Data were pooled with the Mantel-Haenszel method and analyzed based on a random-effects model to estimate the pooled odds ratio and 95% confidence interval. The heterogeneity of studies was evaluated using I statistic.
RESULTS
Twenty studies were included in this meta-analysis of 5,498 patients. The pooled estimate of the odds ratio was 0.46 (95% confidence interval 0.34-0.62; P < .00001) favoring indocyanine green fluorescence angiography. The overall anastomotic leak rate was 3.7% (n = 82) in the intervention group and 8.6% (n = 282) in the control group. Indocyanine green fluorescence angiography led to a change in the anastomotic site in 216 (9.7%) patients. Subgroup analyses of anastomotic leakage requiring intervention, patients requiring a low colorectal anastomosis, and prospective studies had a pooled estimate of odds ratio 0.55 (95% confidence interval 0.35-0.89), odds ratio 0.38 (95% confidence interval 0.27-0.54; P < .0001), and odds ratio 0.49 (95% confidence interval 0.30-0.81; P = .005) respectively.
CONCLUSION
The use of indocyanine green fluorescence angiography is associated with a decrease in anastomotic leakage. This association is present in patients with severe anastomotic leakage requiring intervention as well as low colorectal anastomoses.
背景
结直肠切除术后吻合口漏会给患者带来严重后果。吲哚菁绿荧光血管造影是一种用于可视化吻合口血管灌注的方法，可以帮助外科医生判断吻合口的活力。我们进行了这项系统评价和荟萃分析，以评估吲哚菁绿荧光血管造影减少吻合口漏的效果。
方法
我们检索了 PubMed、Web of Science、Embase 和 Cochrane Library，以确定比较吲哚菁绿荧光血管造影与标准护理在吻合口漏发生率方面的研究。使用 Mantel-Haenszel 方法汇总数据，并基于随机效应模型进行分析，以估计汇总优势比和 95%置信区间。使用 I 统计量评估研究的异质性。
结果
这项荟萃分析纳入了 20 项研究，共 5498 例患者。汇总的优势比估计值为 0.46（95%置信区间 0.34-0.62；P<0.00001），表明吲哚菁绿荧光血管造影有利。干预组的总体吻合口漏发生率为 3.7%（n=82），对照组为 8.6%（n=282）。吲哚菁绿荧光血管造影导致 216 例（9.7%）患者吻合口部位发生改变。需要干预的吻合口漏、低位直肠结肠吻合术和前瞻性研究的亚组分析的汇总优势比估计值分别为 0.55（95%置信区间 0.35-0.89）、0.38（95%置信区间 0.27-0.54；P<0.0001）和 0.49（95%置信区间 0.30-0.81；P=0.005）。
结论
使用吲哚菁绿荧光血管造影可降低吻合口漏的发生率。这种关联在需要干预的严重吻合口漏和低位直肠结肠吻合术患者中均存在。
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