吲哚菁绿荧光显像技术在腹腔镜左半结肠切除术中的应用

Application of indocyanine green fluorescence imaging in laparoscopic left hemicolectomy

目的评价吲哚菁绿(indocyanine green,ICG)荧光显像技术在腹腔镜左半结肠切除术中对肠管吻合血供情况显像的临床价值。方法回顾性分析2017年1月-2020年1月厦门市海沧医院收治的90例行腹腔镜左半结肠切除术的患者,其中术中应用吲哚菁绿荧光显像技术的患者46例(ICG组),常规行腹腔镜左半结肠切除术的患者44例(对照组),分别观察手术时间、术中出血量、术后首次肛门排气时间、术后首次流质饮食时间、术后住院时间及吻合口瘘发生数量和因吻合口瘘导致的死亡数量。结果两组患者均顺利完成手术,无围手术期严重并发症及死亡患者。ICG组与对照组相比,除手术时间[(149.11±11.97)min vs(148.57±11.24)min],(P=0.826,P>0.05),差异无统计学意义外,术中失血量[(89.35±12.65)ml vs(97.84±9.82)ml]、术后首次肛门排气时间[(2.85±0.33)d vs(3.52±0.49)d]、术后进食流质时间[(4.62±0.45)d vs(5.34±0.44)d]、术后住院时间[(10.93±0.74)d vs(13.95±8.69)d]差异均有统计学意义(P<0.001),两组患者在吻合口瘘率发生上也存在明显差异(P=0.025,P<0.05)。结论腹腔镜左半结肠切除术中应用ICG荧光显像技术可以实现术中对结肠血流动态显像,加快吻合时间,减少术中出血以及充分保证吻合口血供,降低因血供差而导致吻合口瘘的发生率,进而加速术后康复,保障手术安全,具有良好的应用前景。

Objective To evaluate the clinical value of indocyanine green(ICG)fluorescence imaging techniquein laparoscopic left hemicolectomy for visualizing the blood supply to the intestinal anastomosis.Methods 90 patients who underwent laparoscopic left hemicolectomy in Haicang Hospital of Xiamen Province from January 2017 to January 2020 were analyzed retrospectively,including 46 patients with intraoperative indocyanine green fluorescence imaging(ICG group)and 44 patients with conventional laparoscopic left hemicolectomy(control group).The operation time,intraoperative blood loss,first postoperative anal exhaust time,first postoperative liquid diet time,postoperative hospital stays,the number of anastomotic leakage,and the number of deaths caused by anastomotic leakage were observed and recorded.Results Patients in both groups underwent the operation successfullywithout serious perioperative complications or death occurred.The operation time of patients between the two groups had no significant difference[(149.11±11.97)minutes vs(148.57±11.24)minutes],(P=0.826,P>0.05).Except for operation time,the patients in ICG group and control group were significantly different(P<0.001)in intraoperative blood loss[(89.35±12.65)ml vs(97.84±9.82)ml],first postoperative anal exhaust time[(2.85±0.33)days vs(3.52±0.49)days],first postoperative liquid diet time[(4.62±0.45)days vs(5.34±0.44)days]and postoperative hospital stays[(10.93±0.74)days vs(13.95±8.69)days].Besides,the incidence of anastomotic leakage between two groups was also significantly different(P=0.025,P<0.05).Conclusion The application of ICG fluorescence imaging in left hemicolectomy can realize dynamic imaging of the blood flow of colonic vascular during operation,speed up the time of anastomosis,reduce intraoperative blood loss,fully ensure anastomotic blood supply,reduce anastomotic leakage and inflammatory edema caused by poor blood supply,accelerate postoperative recovery and ensure the safety of operation.Thus,ICG fluorescence imaging in left hemicolectomy has a good application prospect.