Department of Gastrointestinal Surgery, 556508The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Laboratory Medicine, 556508The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Am Surg. 2021 Dec;87(12):1910-1919. doi: 10.1177/0003134820982848. Epub 2020 Dec 30.
Indocyanine green (ICG) fluorescence angiography is a new technique that help surgeons to assess the blood perfusion of the anastomotic intestine. The aim of this study is to evaluate whether ICG fluorescence angiography can reduce the anastomotic leakage (AL) rate after colorectal anastomoses for rectal cancer (RC) patients.
Studies comparing AL rates between use and nonuse of ICG fluorescence angiography up to April 2020 were systematically searched from PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure. A pooled analysis was performed for the available data regarding the baseline features, AL rate, and other surgical outcomes. ReMan 5.3 software was used to perform the statistical analysis. Quality evaluation and publication bias were also conducted.
Thirteen studies with a total of 2593 patients (1121 in the ICG group and 1472 in the control group) undergoing colorectal anastomoses after RC surgery were included. In the pooled analysis, the baseline data, operation time, and intraoperative blood loss in 2 groups were all comparable and without significant heterogeneity. However, the AL rate in the ICG group was significantly lower (OR .31; 95% CI .22-.44; < .00001) than that in the control group. Additionally, ICG fluorescence angiography was associated with a decreased overall complication rate (OR .60; 95% CI .47-.76; < .0001) in patients who undergo RC surgery.
The present study revealed that ICG fluorescence angiography reduced AL rate after colorectal anastomoses for RC patients. However, more high-quality randomized controlled trials are needed to confirm this benefit.
吲哚菁绿（ICG）荧光血管造影是一种新技术，可以帮助外科医生评估吻合肠的血液灌注情况。本研究旨在评估 ICG 荧光血管造影是否可以降低直肠癌（RC）患者结直肠吻合术后吻合口漏（AL）的发生率。
系统检索了截至 2020 年 4 月PubMed、Embase、Web of Science、Cochrane 图书馆和中国知网中比较使用和不使用 ICG 荧光血管造影的 AL 发生率的研究。对可用的基线特征、AL 发生率和其他手术结果数据进行了汇总分析。使用 ReMan 5.3 软件进行统计分析。还进行了质量评估和发表偏倚分析。
共纳入 13 项研究，共计 2593 例接受 RC 手术后行结直肠吻合术的患者（ICG 组 1121 例，对照组 1472 例）。在汇总分析中，两组的基线数据、手术时间和术中出血量均相似，且无显著异质性。然而，ICG 组的 AL 发生率明显较低（OR.31；95%CI.22-.44；<.00001）。此外，ICG 荧光血管造影与 RC 手术后患者总并发症发生率降低相关（OR.60；95%CI.47-.76；<.0001）。
本研究表明，ICG 荧光血管造影可降低 RC 患者结直肠吻合术后 AL 的发生率。然而，需要更多高质量的随机对照试验来证实这一益处。
