Ospedali Riuniti Marche Nord, Pesaro, Italy.
Colorectal Dis. 2021 Aug;23(8):2189-2194. doi: 10.1111/codi.15680. Epub 2021 May 5.
Although there is growing evidence to support the feasibility of a minimally invasive approach for acute small bowel obstruction, the inability to adequately evaluate compromised bowel segments has been cited as a major limitation. The aim of this work is to report a novel application of extemporaneous indocyanine green (ICG) fluorescence to assess bowel viability where there is a concern for ischaemic damage.
After the cause of obstruction has been identified and resolved, and where there are dubious signs of bowel ischaemia present, fluorescent selective angiography is undertaken. The segment of bowel in question is observed under both normal and fluorescent light to assess local microcirculation. The adequacy of both the arterial supply and the venous drainage is thus appraised to define bowel viability.
Among 71 patients who have undergone surgery for acute small bowel obstruction with a laparoscopic approach, seven received extemporaneous ICG fluorescence assessment of bowel viability. Different presentations with their relevant management are described.
Selective use of intraoperative fluorescent angiography may overcome some of the intrinsic limitations of laparoscopy in assessing bowel viability during surgery for acute small bowel obstruction.
虽然越来越多的证据支持微创方法治疗急性小肠梗阻的可行性，但无法充分评估受损肠段一直被认为是一个主要限制。本研究旨在报告一种新的应用即时吲哚菁绿（ICG）荧光评估缺血性损伤相关肠缺血的方法。
在确定并解决梗阻原因后，如果存在可疑的肠缺血迹象，则进行荧光选择性血管造影。观察有疑问的肠段在正常和荧光下的情况，以评估局部微循环。因此，评估动脉供应和静脉引流的充分性以确定肠的活力。
在 71 例行腹腔镜手术治疗急性小肠梗阻的患者中，有 7 例接受了即时 ICG 荧光评估肠活力。描述了不同的表现及其相关处理。
术中荧光血管造影的选择性使用可能克服腹腔镜在评估急性小肠梗阻手术中肠活力时的一些固有局限性。
