Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan Province, China.
Department of Gastrointestinal Surgery, Mei Shan People's Hospital, Mei Shan, 620010, Sichuan Province, China.
Langenbecks Arch Surg. 2023 May 9;408(1):186. doi: 10.1007/s00423-023-02887-4.
Anastomotic leakage (AL) is one of the severe complications after rectal surgery, and anastomotic ischemia is one of the main factors. This prospective in vivo pilot study aimed to evaluate the effectiveness of Sidestream Dark Field (SDF) imaging in quantitative assessment of anastomotic microcirculation and to analyze its correlation with AL.
Thirty-three patients with rectal cancer who underwent laparoscopic low anterior resection from 2019 to 2020 were enrolled. Microcirculation was measured by SDF imaging at the descending colon, the mesocolon transection line (MTL), and 1 cm and 2 cm distal to the MTL. Anastomotic microcirculation was measured at the stapler anvil edge before anastomosis. Quantitative perfusion-related parameters were as follows: microcirculation flow index (MFI), perfused vessel density (PVD), proportion of perfused vessels (PPV), and total vessel density (TVD).
All patients obtained stable microcirculation images. Functional microcirculation parameters (MFI, PPV, PVD) decreased successively from the descending colon, the colon at MTL, and 1 cm and 2 cm distal to the MTL (all P < 0.01). Extremely poor microcirculation was found at the intestinal segment 2 cm distal to the MTL. Micro-perfusion was significantly lower at the colonic limb of the anastomosis compared with the descending colon (all P < 0.001). Anastomotic leakage occurred in 3 patients (9.1%) whose anastomotic microcirculation was significantly lower than those without AL (all P < 0.01). Blood perfusion at the colonic limb of the anastomosis was significantly higher in patients with left colic artery preservation than in controls.
SDF imaging is a promising technique for evaluating anastomotic microcirculation and has potential clinical significance for risk stratification of AL.
吻合口漏（AL）是直肠手术后的严重并发症之一，而吻合口缺血是主要因素之一。本前瞻性体内初步研究旨在评估边流暗场（SDF）成像在定量评估吻合口微循环中的有效性，并分析其与 AL 的相关性。
纳入 2019 年至 2020 年间行腹腔镜低位前切除术的 33 例直肠癌患者。通过 SDF 成像测量降结肠、横结肠系膜切线（MTL）以及 MTL 远端 1cm 和 2cm 处的微循环。在吻合前测量吻合器砧座边缘的吻合口微循环。定量灌注相关参数如下：微循环血流指数（MFI）、灌注血管密度（PVD）、灌注血管比例（PPV）和总血管密度（TVD）。
所有患者均获得稳定的微循环图像。功能微循环参数（MFI、PPV、PVD）从降结肠、MTL 处结肠以及 MTL 远端 1cm 和 2cm 处依次降低（均 P < 0.01）。MTL 远端 2cm 处肠段微循环极差。吻合口结肠支的微灌注明显低于降结肠（均 P < 0.001）。发生吻合口漏的 3 例患者（9.1%）吻合口微循环明显低于无 AL 患者（均 P < 0.01）。保留左结肠动脉的患者吻合口结肠支的血流灌注明显高于对照组。
SDF 成像技术是评估吻合口微循环的一种有前途的技术，对 AL 的风险分层具有潜在的临床意义。
