术中吲哚菁绿荧光显像评估在降低腹腔镜直肠癌术后吻合口漏的应用价值

doi:10.16139/j.1007-9610.2023.03.012

摘要/Abstract

摘要：

目的：分析腹腔镜直肠癌前切除术中吲哚菁绿评估乙状结肠-直肠吻合口血供情况对减少术后吻合口漏的作用。方法：采用回顾性队列研究方法，收集2019年1月至2022年12月期间在仁济医院胃肠外科接受腹腔镜手术的175例直肠癌连续病例的临床资料。根据是否使用吲哚菁绿显示吻合口血供情况，分为吲哚菁绿组（n=65）和对照组（n=110），比较两组术中情况、术后并发症发生等。结果：吲哚菁绿组手术时间比对照组时间长[（151.6 ± 4.8) min vs. (139.5 ± 3.7) min，P=0.04]，且预防性造口率低于对照组（12.3% vs. 34.6%，P=0.01），而在其他术中情况（术中出血量、淋巴结清扫数目）的比较中两组差异无统计学意义（P>0.05）。术后并发症的比较中，吲哚菁绿组吻合口漏发生率明显低于传统组（4.6% vs. 14.6%，P=0.04）；而在切口感染、尿潴留、肠梗阻等其他并发症的比较中，差异无统计学意义（P>0.05）。结论：腹腔镜直肠癌前切除手术中采用吲哚菁绿评估吻合口血供情况，可以在一定程度上降低吻合口漏发生率，提高手术安全性，有利于改善病人术后生活质量，有临床推广价值。

关键词: 腹腔镜, 直肠癌前切除术, 吲哚菁绿, 吻合口漏

Abstract:

Objective To investigate the effect of indocyanine green(ICG) fluorescence imaging to indicate blood supply of sigmoid-rectal anastomosis in laparoscopic anterior resection of rectal cancer. Methods Here a retrospective cohort study including 175 consecutive patients with rectal cancer scheduled for laparoscopic surgery in Department of Gastrointestinal Surgery of Renji Hospital between January 2019 and December 2022 was analysed. These patients were classified into two groups, according to using ICG or not within surgery: the ICG group (n=65) and the control group (n=110). Operation situations and complications were compared between the two groups. Results The operation time of ICG group was longer than that of control group [(151.6±4.8) min vs (139.5±3.7) min, P=0.04], and the preventive ileostomy rate was lower than that of control group (12.3% vs 34.6%, P=0.01), while the other operation data (intraoperative blood loss, number of lymph node dissection), were similar between the two groups (P>0.05). The rate of anastomotic leakage in ICG group were lower than that in control group (4.6% vs 14.6%, P=0.04), and there was no significant differences in wound infection, urinary retention and intestinal obstruction between the two groups (P>0.05). Conclusions The ICG displays that the blood supply in laparoscopic anterior resection of rectal cancer can reduce the incidence of anastomotic leakage, which improves the surgical safety and the quality of postoperative life.

Key words: Laparoscopy, Anterior resection of rectal cancer, Indocyanine green, Anastomotic leakage

中图分类号:

R735.37

骆洋, 俞旻皓, 叶光耀, 林海萍, 贡婷月, 李浩, 钟鸣. 术中吲哚菁绿荧光显像评估在降低腹腔镜直肠癌术后吻合口漏的应用价值[J]. 外科理论与实践, 2023, 28(03): 249-253.

LUO Yang, YU Minhao, YE Guangyao, LIN Haiping, GONG Tingyue, LI Hao, ZHONG Ming. Efficacy of intraoperative indocyanine green fluorescence imaging evaluation for preventing anastomotic leakage after laparoscopic rectal cancer surgery[J]. Journal of Surgery Concepts & Practice, 2023, 28(03): 249-253.

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Clinicopathological features	Control group （n=110）	ICG group （n=65）	Statistical value	P value
Gender
Male	62 (56.4)	40 (61.5)	χ²=0.45	0.50
Female	48 (43.6)	25 (38.5)	χ²=0.45	0.50
Age(years)	62.2±1.0	63.9±0.9	t=1.17	0.24
BMI (kg/m²)	21.8± 0.3	21.9±0.4	t=0.28	0.78
Tumor size (cm)	4.6±0.2	4.4±0.3	t=0.59	0.56
Preoperative CEA (μg/mL)	18.2± 8.1	22.5±10.9	t=0.32	0.75
TNM Stage
Stage Ⅰ	8 (7.3)	5 (7.7)	χ²=0.66	0.71
Stage Ⅱ	66 (60.0)	35 (53.8)
Stage Ⅲ	36 (32.7)	25 (38.5)

Postoperative recovery	Control group （n=110）	ICG group （n=65）	Statistical value	P value
First postoperative anal ventilation time （h）	75.4±1.7	72.0±2.4	t=1.18	0.24
Postoperative hospitalization time （d）	10.4±0.6	9.7±0.7	t=0.70	0.49
Anastomotic leakage
Yes	16 (14.5)	3 (4.6)	χ²=4.16	0.04
No	94 (85.5)	62 (95.4)
Urinary retention
Yes	10(9.1)	7 (10.8)	χ²=0.13	0.72
No	100 (90.9)	58 (89.2)
Wound infection
Yes	11 (10.0)	6 (9.2)	χ²=0.28	0.87
No	99 (90.0)	59 (90.8)
Intestinal obstruction
Yes	7 (6.4)	3 (4.7)	χ²=0.23	0.63
No	103 (93.6)	62(95.4)

Clinicopathological feature	Control group （n=110）	ICG group （n=65）	t value	P value
Bleeding volume （mL）	109.3±6.1	117.7±8.8	0.81	0.42
Operative time （min）	139.5± 3.7	151.6±4.8	2.01	0.04
Preventive stoma (case)	38 (34.6)	8 (12.3)	6.29	0.01
Number of lymph node	12.7±0.5	13.1±0.7	0.45	0.65