原始荧光模式下吲哚菁绿荧光血管造影技术辅助直肠癌根治术中保留左结肠动脉可行性研究

Feasibility of indocyanine green fluorescence angiography under the original fluorescence mode to assist left colic artery preserving during rectal cancer resection

目的探讨原始荧光模式下吲哚菁绿(ICG)荧光血管造影技术辅助直肠癌根治术中肠系膜下动脉(IMA)分支分型及保留左结肠动脉(LCA)的可行性。方法回顾性分析2022年6~12月在中国医学科学院肿瘤医院由同一术者手术治疗的32例直肠癌病人的资料。采用高分辨增强CT影像技术、ICG荧光血管造影技术判断IMA分型,并与IMA裸化后解剖分型比较。观察影像分型、荧光分型与解剖分型的符合率,分析ICG荧光血管造影技术辅助LCA保留的近期结局。结果32例术前影像分型:Ⅰ型15例(46.8.%),Ⅱ型7例(21.9%),Ⅲ型4例(12.5%),Ⅳ型3例(9.4%),未能辨认分型3例(9.4%);术中均顺利完成IMA血管分型,包括Ⅰ型17例(53.1%),Ⅱ型11例(34.3%),Ⅲ型2例(6.3%),Ⅳ型2例(6.3%)。影像分型符合率为81.3%,荧光分型符合率为100%,两者差异有统计学意义(P=0.032)。除2例Ⅳ型,其余30例均成功保留LCA。IMA根部淋巴结清扫时间(15.5±7.1)min,术后住院时间中位数7(6,8)d。无中转开放手术病例。1例发生术后腹腔出血,行二次手术止血,无肠梗阻、吻合口漏等并发症发生。结论原始荧光模式下术中ICG荧光血管造影技术较术前影像判断IMA分支分型准确率更高,并可辅助LCA保留,值得临床进一步关注和研究。

Objective To explore the feasibility of using indocyanine green(ICG)fluorescence angiography under the original fluorescence mode to assist in the classification of the inferior mesenteric artery(IMA)branches and the preservation of the left colic artery(LCA)during radical resection of rectal cancer.Methods A total of 32 patients with rectal cancer who underwent surgical treatment by the same surgeon were retrospectively analyzed at the Cancer Hospital of the Chinese Academy of Medical Sciences between June and December 2022.High-resolution enhanced CT imaging and ICG fluorescence angiography were used to determine the IMA classification and compared with the anatomical classification.The consistency rate between the imaging classification,fluorescence classification,and anatomical classification was observed,and the feasibility of preserving the LCA with the assistance of ICG fluorescence angiography was analyzed in terms of short-term outcomes.Results Preoperative imaging classification included Type Ⅰ in 15 cases(46.8%),Type Ⅱ in 7 cases(21.9%),Type Ⅱ in 4 cases(12.5%),Type Ⅳ in 3 cases(9.4%),and unrecognizable in 3 cases(9.4%).All 32 cases successfully completed IMA vascular fluorescence classification during surgery,including Type Ⅰ in 17 cases(53.1%),Type Ⅱ in Ⅱ cases(34.3%),Type III in 2 cases(6.3%),and Type IV in 2 cases(6.3%).The consistenicy rate between theimi aging classification and fluorescence classification was 81.3%,and the consistency rate between the fluorescence classification and anatomical classification was 100%,with a statistical difference(P=0.032).Except for 2 cases of Type IV,LCA was successfully preserved in the remaining 30 cases.The mean time for IMA root lymph node dissection was(15.5±7.1)min,and the median postoperative hospital stay was 7(6,8)days.No cases required conversion to open surgery.One case experienced postoperative abdominal bleeding,which was managed with a second operation.No complications such as intestinal obstruction or anastomotic leakage occurred.Conclusion ICG fluorescence angiography under the original fluorescence mode can improve the accuracy of IMA branch classification compared with preoperative imaging classification and can assist in the preservation of LCA,which deserves further clinical attention and research.