Application of real-time indocyanine green fluorescence imaging navigation technology in rectal cancer surgery
杨勇 1李姗姗 1张正国 1黄路桥 1谢光伟 1孟庆良1
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作者信息
1. 徐州市中心医院肛肠科(江苏徐州 221009)
折叠
摘要
目的 探讨实时吲哚菁绿荧光成像导航(indocyanine green fluorescence imaging navigation,ICG-FIN)技术在腹腔镜直肠癌根治术中的应用价值.方法 按照纳入和排除标准回顾性收集2022年4月至2023年6月期间徐州市中心医院肛肠科收治且采用ICG-FIN的腹腔镜直肠癌手术患者(ICG-FIN组),同时采用倾向性评分匹配法以1:1匹配2021年1月至2022年5月期间未使用ICG-FIN行常规腹腔镜手术患者作为对照组,比较2组的一般资料、手术情况、术中及术后结果.结果 本研究ICG-FIN组62例,同时匹配了 62例患者作为对照组,2组患者的性别、年龄、身体质量指数、合并症等资料比较差异无统计学意义(P＞0.05).ICG-FIN组术中均可见瘤体定位、淋巴结示踪、预切肠管及吻合口处均荧光显像,术中有7例(11.3％)患者预切肠吻合线改变,对照组无手术计划改变.2组患者在手术方式选择、手术时间、术中出血量、回肠造口比例、术后首次排气时间、术后住院时间及短期并发症发生率方面比较差异均无统计学意义(P＞0.05),ICG-FIN组吻合口漏发生率低于对照组且差异有统计学意义(P=0.012),清扫淋巴结数目ICG-FIN组多于对照组(P=0.016),但2组检出阳性淋巴结数目比较差异无统计学意义(P=0.343).结论 从本研究结果提示,ICG-FIN技术在腹腔镜直肠癌手术中可以准确定位肿瘤、示踪淋巴结、指导术中淋巴结清扫,可实时评估吻合口段肠管血流灌注对降低吻合口漏具有一定的优势.
Abstract
Objective To evaluate the value of real-time indocyanine green fluorescence imaging navigation(ICG-FIN)in laparoscopic rectal cancer surgery.Methods The patients who adopted ICG-FIN during laparoscopic rectal cancer surgery in the Department of Anorectal Surgery of Xuzhou Central Hospital from April 2022 to June 2023 according to the inclusion and exclusion criteria(ICG-FIN group)were collected,meanwhile matching(1:1)of patients who did not adopt ICG-FIN during laparoscopic surgery from January 2021 to May 2022(control group).The general data,surgical conditions,intraoperative and postoperative outcomes between the two groups were compared.Results There were 62 patients in the ICG-FIN group and 62 patients in the control group.There were no statistical differences in the gender,age,body mass index,comorbidities,and so on between the two groups(P＞0.05).The tumor localization,lymph node tracing,fluorescence imaging of the intended resection of intestinal tract and anastomotic site were observed in the ICG-FIN group.Seven patients(11.3％)had changed in the intended resection of intestinal anastomotic line during surgery,while there were no changes of the surgical plan in the control group.There were no statistical differences(P＞0.05)in terms of surgical method,operative time,intraoperative bleeding,proportion of ileostomy,time of the first postoperative exhaust,postoperative hospital stay,and incidence of short-term complications between the two groups.Compared with the control group,the incidence of anastomotic leakage was lower(P=0.012),and the number of lymph nodes cleaned was more(P=0.016)in the ICG-FIN group.However,there was no statistical difference in the number of positive lymph nodes detected between the two groups(P=0.343).Conclusions According to the results of this study,ICG-FIN is a reliable and effective method during laparoscopic rectal cancer surgery,which can accurately localize tumor,trace and guide lymph node dissection.Real-time evaluation of intestinal blood flow perfusion is of great practical value in reducing anastomotic leakage.
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