Clinical utility of transanal indocyanine green near-infrared fluorescence imaging for evaluation of colorectal anastomotic perfusion

被引：22

作者：

Amagai, Hiroyuki ^{[1
]}

Miyauchi, Hideaki ^{[1
]}

Muto, Yorihiko ^{[2
]}

Uesato, Masaya ^{[1
]}

Ohira, Gaku ^{[1
]}

Imanishi, Shunsuke ^{[1
]}

Maruyama, Tetsuro ^{[1
]}

Tochigi, Toru ^{[1
]}

Okada, Koichiro ^{[1
]}

Maruyama, Michihiro ^{[1
]}

Matsubara, Hisahiro ^{[1
]}

机构：

[1] Chiba Univ, Dept Frontier Surg, Grad Sch Med, Chuo Ku, 1-8-1 Inohana, Chiba 2608670, Japan

[2] Tsujinaka Hosp, Kashiwa, Chiba, Japan

来源：

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2020年 / 34卷 / 12期

基金：

日本学术振兴会;

关键词：

Indocyanine green; Perfusion; Fluorescence; Colorectal; Anastomosis; LOW ANTERIOR RESECTION; RECTAL-CANCER; RISK-FACTORS; LEAKAGE; ANGIOGRAPHY; SURGERY;

D O I：

10.1007/s00464-019-07315-7

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background Although indocyanine green (ICG) fluorescence imaging has been reported to be useful for assessing colorectal perfusion, unstable quantification remains an issue. We performed ICG fluorescence observation from the luminal side and examined the usefulness of the transanal approach. Methods A total of 69 patients who underwent left-side colon surgery were enrolled in this cohort study. After the anastomosis had been constructed, ICG 0.2 mg/kg was injected intravenously. The anastomotic site was then observed by a scope inserted transanally. The following items were examined in the areas of the anastomotic site with the highest- and lowest-fluorescence intensity: maximum fluorescence (Fmax), time from ICG injection to Fmax (Tmax), time from start of dyeing to Fmax (Delta T), and the contrast pattern of the mucosa. Results Anastomotic leakage (AL) occurred in nine cases. Tmax and Delta T values of the lowest-fluorescence area in the distal intestine showed significant differences in the cases with AL (P = 0.015 andP = 0.040, respectively). Regarding the contrast pattern of the mucosa of the lowest-fluorescence area in the proximal and distal intestine, the patients in whom the vessels were not depicted in the area had a significantly higher incidence of AL than those in whom vessels were depicted in the area (P = 0.031 andP = 0.030, respectively). Some of the areas in which vessels were not depicted by ICG fluorescence observation from the luminal side corresponded to the points of leakage. There were heterogeneous changes that might not be grasped by observation from the serosal side. Conclusion Transanal ICG fluorescence imaging can evaluate perfusion over the entire circumference of the anastomosis in detail and aid in assessing the risk of AL. Therefore, the examination of the detailed low-perfusion area enables us to take measures for AL and to search for safer operative managements.

引用

页码：5283 / 5293

页数：11

共 27 条

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