Son Gyung Mo, Ahn Hong-Min, Lee In Young, Lee Sun Min, Park Sang-Ho, Baek Kwang-Ryul
Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
J Minim Invasive Surg. 2021 Sep 15;24(3):113-122. doi: 10.7602/jmis.2021.24.3.113.
Anastomotic complications occur after 5% to 20% of operations for rectosigmoid colon cancer. The intestinal perfusion status at the anastomotic site is an important modifiable risk factor, and surgeons should carefully evaluate and optimize the perfusion at the intended site of anastomosis. Indocyanine green (ICG) angiography is a simple noninvasive perfusion assessment modality. The use of ICG angiography is rapidly spreading in the field of colorectal surgery. However, there is debate on its contribution to reducing anastomotic complications. In this review, we discuss the clinical utility and the standardization of ICG angiography. ICG angiography can unequivocally reveal unfavorable perfusion zones and provide quantitative parameters to predict the risk of hypoperfusion-related anastomotic complications. Many studies have demonstrated the clinical utility of ICG angiography for reducing anastomotic complications. Recently, two multicenter randomized clinical trials reported that ICG angiography did not significantly reduce the incidence of anastomotic leakage. Most previous studies have been small-scale single-center studies, and there is no standardized ICG angiography protocol to date. Additionally, ICG angiography evaluations have mostly relied on surgeons' subjective judgment. For these reasons, it is necessary to establish a standardized ICG angiography protocol and develop a quantitative analysis protocol for the objective assessment. In conclusion, ICG angiography could be useful for detecting poorly perfused colorectal segments to prevent anastomotic leakage after colorectal surgery. An optimized and standardized ICG angiography protocol should be established to improve the reliability of perfusion assessments. In the future, artificial intelligence-based quantitative analyses could be used to easily assess colonic perfusion status.
在5%至20%的直肠乙状结肠癌手术之后会出现吻合口并发症。吻合口部位的肠道灌注状态是一个重要的可改变风险因素，外科医生应仔细评估并优化预期吻合部位的灌注情况。吲哚菁绿（ICG）血管造影是一种简单的非侵入性灌注评估方式。ICG血管造影在结直肠外科领域的应用正在迅速普及。然而，对于其在减少吻合口并发症方面的作用存在争议。在本综述中，我们讨论了ICG血管造影的临床应用及标准化问题。ICG血管造影能够明确显示灌注不良区域，并提供定量参数以预测与灌注不足相关的吻合口并发症风险。许多研究已经证明了ICG血管造影在减少吻合口并发症方面的临床应用价值。最近，两项多中心随机临床试验报告称，ICG血管造影并未显著降低吻合口漏的发生率。此前的大多数研究都是小规模单中心研究，并且迄今为止尚无标准化的ICG血管造影方案。此外，ICG血管造影评估大多依赖外科医生的主观判断。基于这些原因，有必要建立标准化的ICG血管造影方案，并制定用于客观评估的定量分析方案。总之，ICG血管造影可能有助于检测结直肠灌注不良节段，以预防结直肠手术后的吻合口漏。应建立优化和标准化的ICG血管造影方案，以提高灌注评估的可靠性。未来，基于人工智能的定量分析可用于轻松评估结肠灌注状态。
