在结直肠手术中何时以及距离组织多远评估吲哚菁绿，使用 SERGREEN 程序进行定量测量。

When should indocyanine green be assessed in colorectal surgery, and at what distance from the tissue? Quantitative measurement using the SERGREEN program.

机构信息

Unidad de Coloproctología. Servicio de Cirugía General y del Aparato Digestivo, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208, Sabadell, Barcelona, Spain.

Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain.

出版信息

Surg Endosc. 2022 Dec;36(12):8943-8949. doi: 10.1007/s00464-022-09343-2. Epub 2022 Jun 6.

DOI:10.1007/s00464-022-09343-2

PMID:35668312

Abstract

BACKGROUND

Suture dehiscence is one of the most feared postoperative complications. Correct intestinal vascularization is essential for its prevention. Indocyanine green (ICG) is one of the methods used to assess vascularization, but this assessment is usually subjective. Our group designed the SERGREEN program to obtain an objective measurement of the degree of vascularization. We do not know how long after ICG administration the fluorescence of the tissues should be evaluated, or how far away the measurement should be performed. The aim of this study is to establish the optimal moment and distance for analyzing the fluorescence saturation of ICG.

METHODS

Prospective observational study in patients undergoing elective laparoscopic colorectal surgery. The optimal time for ICG analysis was tested in a sample of 20 patients (10 right colon and 10 left colon), and the optimal distance in a sample of ten patients. ICG was administered intravenously, and colon vascularization was quantified using SERGREEN; RGB (Red, Green, Blue) encoding was used. The intensity curve of the ICG was analyzed for ten minutes after its administration. Distances of 1, 3, and 5 cm were tested.

RESULTS

The intensity of fluorescence increased until 1.5 min after ICG administration (reaching figures of 112.49 in the right colon and 93.95 in the left). It then remained fairly stable until 3.5 min (98.49 in the right and 83.35 in the left), at which point it began to decrease gradually. ICG saturation was inversely proportional to the distance between the camera and the tissue. The best distance was 5 cm, where the confidence interval was narrower [CI 86.66-87.53].

CONCLUSION

The optimal time for determining ICG in the colon is between 1.5 and 3.5 min, in both right and left colon. The optimal distance is 5 cm. This information will help to establish parameters of comparison in normal and pathological situations.

摘要

背景

缝合裂开是最可怕的术后并发症之一。正确的肠道血管化对于预防缝合裂开至关重要。吲哚菁绿（ICG）是评估血管化的方法之一，但这种评估通常是主观的。我们的团队设计了 SERGREEN 项目，以获得血管化程度的客观测量。我们不知道在 ICG 给药后多久应该评估组织的荧光，或者应该在多远的距离进行测量。本研究的目的是确定分析 ICG 荧光饱和度的最佳时间和距离。

方法

这是一项在接受择期腹腔镜结直肠手术的患者中进行的前瞻性观察研究。在 20 名患者（10 名右半结肠和 10 名左半结肠）的样本中测试了 ICG 分析的最佳时间，在 10 名患者的样本中测试了最佳距离。静脉注射 ICG，并使用 SERGREEN 对结肠血管化进行量化；使用 RGB（红、绿、蓝）编码。在 ICG 给药后 10 分钟内分析 ICG 的强度曲线。测试了 1、3 和 5 cm 的距离。

结果

荧光强度在 ICG 给药后 1.5 分钟内增加（右半结肠达到 112.49，左半结肠达到 93.95）。然后，它在 3.5 分钟左右保持相当稳定（右半结肠达到 98.49，左半结肠达到 83.35），此时它开始逐渐下降。ICG 饱和度与相机和组织之间的距离成反比。最佳距离为 5 cm，置信区间较窄[CI 86.66-87.53]。