了解回肠贮袋肛管吻合术（带或不带血管结扎）过程中的荧光时间曲线。
Understanding fluorescence time curves during ileal pouch-anal anastomosis with or without vascular ligation.
机构信息
Department of Surgery, Amsterdam University Medical Centres (UMC), Academic Medical Centre (AMC), Postbox 22660, 1100 DD, Amsterdam, The Netherlands.
Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.
出版信息
Surg Endosc. 2023 Jul;37(7):5086-5093. doi: 10.1007/s00464-023-09921-y. Epub 2023 Mar 14.
BACKGROUND
Intraoperative indocyanine green fluorescence angiography (ICG-FA) may be of added value during pouch surgery, in particular after vascular ligations as lengthening maneuver. The aim was to determine quantitative perfusion parameters within the efferent/afferent loop and explore the impact of vascular ligation. Perfusion parameters were also compared in patients with and without anastomotic leakage (AL).
METHODS
All consenting patients that underwent FA-guided ileal pouch-anal anastomosis (IPAA) between July 2020 and December 2021 were included. After intravenous bolus injection of 0.1 mg/kg ICG, the near-infrared camera (Stryker Aim 1688) registered the fluorescence intensity over time. Quantitative analysis of ICG-FA from standardized regions of interests on the pouch was performed using software. Fluorescence parameters were extracted for inflow (T, T, F, slope, Time-to-peak) and outflow (T and T). Change of management related to FA findings and AL rates were recorded.
RESULTS
Twenty-one patients were included, three patients (14%) required vascular ligation to obtain additional length, by ligating terminal ileal branches in two and the ileocolic artery (ICA) in one patient. In nine patients the ICA was already ligated during subtotal colectomy. ICG-FA triggered a change of management in 19% of patients (n = 4/21), all of them had impaired vascular supply (ligated ileocolic/ terminal ileal branches). Overall, patients with intact vascular supply had similar perfusion patterns for the afferent and efferent loop. Pouches with ICA ligation had longer T in both afferent as efferent loop than pouches with intact ICA (afferent 51 and efferent 53 versus 41 and 43 s respectively). Mean slope of the efferent loop diminished in ICA ligated patients 1.5(IQR 0.8-4.4) versus 2.2 (1.3-3.6) in ICA intact patients.
CONCLUSION
Quantitative analysis of ICG-FA perfusion during IPAA is feasible and reflects the ligation of the supplying vessels.
背景
术中吲哚菁绿荧光血管造影（ICG-FA）在袋状手术中可能具有附加价值，尤其是在血管结扎后进行延长操作时。目的是确定输出/输入环中的定量灌注参数，并探讨血管结扎的影响。还比较了有和没有吻合口漏（AL）的患者的灌注参数。
方法
纳入 2020 年 7 月至 2021 年 12 月期间接受 FA 引导的回肠袋肛门吻合术（IPAA）的所有同意患者。静脉注射 0.1mg/kgICG 后，近红外摄像机（Stryker Aim 1688）随时间记录荧光强度。使用软件对袋状标准化感兴趣区域的 ICG-FA 进行定量分析。提取流入（T、T、F、斜率、达峰时间）和流出（T 和 T）的荧光参数。记录与 FA 结果相关的管理变化和 AL 发生率。
结果
共纳入 21 例患者，3 例（14%）需要结扎末端回肠分支（2 例）或结扎回结肠动脉（ICA）（1 例）以获得额外长度。9 例患者在次全结肠切除术中已结扎 ICA。ICG-FA 触发了 21%（n=4/21）患者的管理变化，所有这些患者的血管供应都受损（结扎回结肠/末端回肠分支）。总的来说，血管供应完好的患者输入和输出环的灌注模式相似。ICA 结扎的袋状具有比 ICA 完好的袋状更长的 T（分别为 51 和 53 s 与 41 和 43 s）。ICA 结扎患者的输出环平均斜率降低 1.5（IQR 0.8-4.4），而 ICA 完好患者的斜率为 2.2（1.3-3.6）。
结论
IPAA 期间 ICG-FA 灌注的定量分析是可行的，并反映了供应血管的结扎。
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