经近红外荧光血管造影评估网膜阑尾血供在预防超低位直肠癌经肛门内括约肌间切除术吻合口漏中的作用：一项病例匹配研究。
Blood perfusion assessment by near-infrared fluorescence angiography of epiploic appendages in prevention of anastomotic leakage after laparoscopic intersphincteric resection for ultra-low rectal cancer: a case-matched study.
机构信息
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100000, China.
Department of General Surgery, Peking University First Hospital, Beijing, 100034, China.
出版信息
Surg Endosc. 2024 Sep;38(9):5446-5456. doi: 10.1007/s00464-024-11085-2. Epub 2024 Aug 1.
BACKGROUND
The role of intraoperative near-infrared fluorescence angiography with indocyanine green in reducing anastomotic leakage (AL) has been demonstrated in colorectal surgery, however, its perfusion assessment mode, and efficacy in reducing anastomotic leakage after laparoscopic intersphincteric resection (LsISR) need to be further elucidated.
AIM
Aim was to study near-infrared fluorescent angiography to help identify bowel ischemia to reduce AL after LsISR.
MATERIAL AND METHODS
A retrospective case-matched study was conducted in one referral center. A total of 556 consecutive patients with ultra-low rectal cancer including 140 patients with fluorescence angiography of epiploic appendages (FAEA)were enrolled. Perfusion assessment by FAEA in the monochrome fluorescence mode. Patients were divided into two groups based on perfusion assessment by FAEA. The primary endpoint was the AL rate within 6 months, and the secondary endpoint was the structural sequelae of anastomotic leakage (SSAL).
RESULTS
After matching, the study group (n = 109) and control group (n = 190) were well-balanced. The AL rate in the FAEA group was lower before (3.6% vs. 10.1%, P = 0.026) and after matching (3.7% vs. 10.5%, P = 0.036). Propensity scores matching analysis (OR 0.275, 95% CI 0.035-0.937, P 0.039), inverse probability of treatment weighting (OR 0.814, 95% CI 0.765-0.921, P 0.002), and regression analysis (OR 0.298, 95% CI 0.112-0.790, P = 0.015), showed that FAEA was an independent protector factor for AL. This technique can significantly shorten postoperative hospital stay [9 (6-13) vs. 10 (8-13), P = 0.024] and reduce the risk of SSAL (1.4% vs. 6.0%, P = 0.029).
CONCLUSIONS
Perfusion assessment by FAEA can achieve better visualization in LsISR and reduce the incidence of AL, subsequently avoiding SSAL after LsISR.
背景
术中近红外荧光血管造影联合吲哚菁绿（ICG）已被证实可降低结直肠手术中的吻合口漏（AL），但其灌注评估模式以及在腹腔镜经括约肌间直肠切除术（LsISR）后降低 AL 的效果仍需进一步阐明。
目的
旨在通过近红外荧光血管造影术（NIRFA）帮助识别肠缺血，以降低 LsISR 后的 AL 发生率。
材料与方法
本研究为单中心回顾性病例对照研究，纳入了 556 例接受超低位直肠肿瘤切除术的患者，其中 140 例行荧光造影术。通过 NIRFA 对阑尾（epiploic appendages，EA）的单色调荧光模式进行灌注评估。根据 NIRFA 的灌注评估结果将患者分为两组。主要终点为 6 个月内的 AL 发生率，次要终点为吻合口漏的结构后遗症（SSAL）。
结果
匹配后，研究组（n=109）和对照组（n=190）的基线特征均衡。术前（3.6% vs. 10.1%，P=0.026）和匹配后（3.7% vs. 10.5%，P=0.036），EA 组的 AL 发生率较低。倾向评分匹配分析（OR 0.275，95%CI 0.035-0.937，P=0.039）、逆概率治疗加权分析（OR 0.814，95%CI 0.765-0.921，P=0.002）和回归分析（OR 0.298，95%CI 0.112-0.790，P=0.015）均显示，NIRFA 是 AL 的独立保护因素。该技术可显著缩短术后住院时间[9（6-13）vs. 10（8-13），P=0.024]，降低 SSAL 风险（1.4% vs. 6.0%，P=0.029）。
结论
EA 的 NIRFA 灌注评估可在 LsISR 中获得更好的可视化效果，降低 AL 发生率，进而避免 LsISR 后的 SSAL。
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