Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/ Clara Campoamor 341, Vigo, Pontevedra, Zip Code: 36213, Spain.
Instituto de Investigación Galicia Sur, Pontevedra, Spain.
Int J Colorectal Dis. 2023 Mar 10;38(1):67. doi: 10.1007/s00384-023-04363-3.
Indocyanine green (ICG) was introduced as a promising diagnostic tool to provide real-time assessment of intestinal vascularization. Nevertheless, it remains unclear whether ICG could reduce the rate of postoperative AL. The objective of this study is to assess its usefulness and to determine in which patients is most useful and would benefit the most from the use of ICG for intraoperative assessment of colon perfusion.
A retrospective cohort study was conducted in a single center, including all patients who underwent colorectal surgery with intestinal anastomosis between January 2017 and December 2020. The results of patients in whom ICG was used prior to bowel transection were compared with the results of the patients in whom this technique was not used. Propensity score matching (PSM) was employed to compare groups with and without ICG.
A total of 785 patients who underwent colorectal surgery were included. The operations performed were right colectomies (35.0%), left colectomies (48.3%), and rectal resections (16.7%). ICG was used in 280 patients. The mean time since the infusion of ICG until detection of fluorescence in the colon wall was 26.9 ± 1.2 s. The section line was modified in 4 cases (1.4%) after ICG due to a lack of perfusion in the chosen section line. Globally, a non-statistically significant increase in anastomotic leak rate was observed in the group without ICG (9.3% vs. 7.5%; p = 0.38). The result of the PSM was a coefficient of 0.026 (CI - 0.014 to 0.065, p = 0.207).
ICG is a safe and useful tool to assess the perfusion of the colon prior to performing the anastomosis in colorectal surgery. However, in our experience, it did not significantly lower the anastomotic leakage rate.
吲哚菁绿（ICG）作为一种有前途的诊断工具被引入，用于实时评估肠道血管化。然而，ICG 是否能降低术后吻合口漏（AL）的发生率仍不清楚。本研究旨在评估其有用性，并确定在哪些患者中最有用，以及最能从术中评估结肠灌注时使用 ICG 中获益。
这是一项单中心回顾性队列研究，纳入 2017 年 1 月至 2020 年 12 月期间行结直肠手术并进行肠吻合术的所有患者。比较了术中在肠切开前使用 ICG 的患者与未使用该技术的患者的结果。采用倾向评分匹配（PSM）比较有和无 ICG 组。
共纳入 785 例行结直肠手术的患者。手术类型包括右半结肠切除术（35.0%）、左半结肠切除术（48.3%）和直肠切除术（16.7%）。280 例患者使用了 ICG。从 ICG 注射到检测到肠壁荧光的平均时间为 26.9±1.2 s。由于选择的肠段缺乏灌注，4 例（1.4%）在 ICG 后修改了手术节段线。总体而言，无 ICG 组吻合口漏发生率略有升高，但无统计学意义（9.3%比 7.5%；p=0.38）。PSM 的结果为系数 0.026（CI-0.014 至 0.065，p=0.207）。
ICG 是一种安全且有用的工具，可在结直肠手术行吻合术之前评估结肠的灌注情况。然而，在我们的经验中，它并未显著降低吻合口漏的发生率。
