吲哚菁绿引导保留直肠上血管在腹腔镜下乙状结肠癌根治术中的安全性及可行性

Safety and feasibility analysis of indocyanine green guided preservation of upper rectal vessels in laparoscopic radical resection of sigmoid cancer

目的探讨在行腹腔镜下乙状结肠癌根治术的患者中,应用吲哚菁绿引导保留直肠上动脉(SRA)的安全性及可行性。方法回顾性分析2019年10月至2024年2月在徐州市中心医院普外科确诊乙状结肠癌行根治性手术的患者73例。根据手术方法将患者分为保留SRA组(行保留SRA的乙状结肠癌根治术,n=30)和高位结扎组(肠系膜下动脉高位根部结扎,n=43)。比较两组手术时间、术中出血量、吻合口瘘发生情况、淋巴结清扫总数等指标。结果所有患者均顺利完成手术,无围手术期死亡病例。两组手术时间、术中出血量、淋巴结清扫总数差异均无统计学意义(P>0.05),对照组患者吻合口瘘发生率略高于SRA组,但差异无统计学意义[14.0%(6/43)vs 0,χ^(2)=2.899,P=0.089]。结论在腹腔镜乙状结肠癌根治手术中,应用吲哚菁绿引导保留SRA并且保证清扫253组淋巴结与传统肠系膜下动脉高位根部结扎相比,不影响手术时间、出血量、手术安全性或切除的淋巴结数目,对减少吻合口瘘的发生有一定作用。

Objective To investigate the safety and feasibility of indocyanine green guided preservation of the superior rectal artery in patients undergoing laparoscopic radical resection for sigmoid cancer.Methods A total of 73 patients who underwent laparoscopic radical resection of sigmoid cancer in the Department of General Surgery of Xuzhou Central Hospital from October 2019 to February 2024 were analyzed retrospectively.The patients were randomly divided into SRA group(superior rectal artery preservation,n=30)and control group(inferior mesenteric artery high ligation,n=43).The operation time,intraoperative blood loss,incidence of anastomotic fistula and total number of lymph node dissection were compared between the two groups.Results All patients completed the operation successfully and there was no perioperative death.There was no significant difference in operation time,intraoperative blood loss and total number of lymph node dissection between two groups(P>0.05).The incidence rate of anastomotic fistula in control group was slightly higher than that in SRA group,but the difference was not significant[14.0%(6/43)vs 0,χ^(2)=2.899,P=0.089].Conclusion In laparoscopic radical resection for sigmoid cancer,the application of indocyanine green-guided preservation of SRA while ensuring the clearance of group 253 lymph nodes,compared to traditional high ligation of the inferior mesenteric artery,does not affect the duration of surgery,blood loss,surgical safety,or the number of excised lymph nodes.It plays a certain role in reducing the occurrence of anastomotic fistula.