Gach Tomasz, Bogacki Paweł, Orzeszko Zofia, Markowska Beata, Krzak Jan M, Szura Maciej, Solecki Rafał, Szura Mirosław
Department of General and Oncological Surgery, Hospital of Brothers Hospitallers of St. John of God, Krakow, Poland.
Department of Surgery, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
Wideochir Inne Tech Maloinwazyjne. 2023 Sep;18(3):410-417. doi: 10.5114/wiitm.2023.129545. Epub 2023 Jul 17.
Anastomotic leakage is one of the most dangerous complications after rectal surgery. It can cause systemic complications, reduce the quality of life and worsen the results of oncological treatment. One of the causes of anastomotic leak is insufficient blood supply to the anastomosis. Intraoperative infrared angiography with indocyanine green (ICG) is expected to improve the assessment of intestinal perfusion and thus prevent anastomotic leakage.
To present the results of the use of ICG intraoperative angiography during rectal surgery in the prevention of anastomotic leakage.
The study included 76 patients undergoing rectal cancer surgery. Patients were randomized to 2 groups: Group I - 41 patients with ICG intraoperative angiography; and Group II - 35 patients without ICG imaging. Anastomotic leak, length of hospitalization, and complication rate were compared.
Group I patients received intravenous ICG before the anastomosis. Average time of intestinal wall contrasting was 42 s (22-65 s). Average ICG procedure time was 4 min (3.2% of total time of surgery). Three (7.3%) patients after angiography revealed intestinal ischemia requiring widened resection. No anastomotic leak was found post-operatively, and no side effects were observed after administration of ICG. In group II, 3 (8.6%) anastomotic leakages were diagnosed, 2 of which required reoperation.
Intraoperative angiography with ICG in near-infrared light is a safe and effective method of assessing intestinal perfusion. ICG angiography may change the surgical plan and reduce the risk of anastomotic leakage. It is necessary to continue the study until the assumed number of patients is reached.
吻合口漏是直肠手术后最危险的并发症之一。它可导致全身并发症，降低生活质量并使肿瘤治疗效果恶化。吻合口漏的原因之一是吻合口血供不足。术中使用吲哚菁绿（ICG）进行红外血管造影有望改善对肠灌注的评估，从而预防吻合口漏。
介绍在直肠手术中使用ICG术中血管造影预防吻合口漏的结果。
该研究纳入了76例接受直肠癌手术的患者。患者被随机分为两组：第一组 - 41例接受ICG术中血管造影的患者；第二组 - 35例未进行ICG成像的患者。比较吻合口漏、住院时间和并发症发生率。
第一组患者在吻合术前接受静脉注射ICG。肠壁显影的平均时间为42秒（22 - 65秒）。ICG操作的平均时间为4分钟（占手术总时间的3.2%）。血管造影后有3例（7.3%）患者出现肠缺血，需要扩大切除范围。术后未发现吻合口漏，注射ICG后未观察到副作用。在第二组中，诊断出3例（8.6%）吻合口漏，其中2例需要再次手术。
近红外光下使用ICG进行术中血管造影是评估肠灌注的一种安全有效的方法。ICG血管造影可能会改变手术方案并降低吻合口漏的风险。有必要继续进行研究，直至达到假定的患者数量。
