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中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 688 -691. doi: 10.3877/cma.j.issn.1674-3946.2022.06.027

论著

ICG显影技术辅助吻合口血运判断在保留左结肠动脉的腹腔镜直肠癌根治术中临床意义研究
张中华1, 刘扬1, 毛伟明1, 陈峰1,(), 杜恒1   
  1. 1. 438000 湖北黄冈,黄冈市中心医院普通外科
  • 收稿日期:2021-11-11 出版日期:2022-12-26
  • 通信作者: 陈峰

Clinical significance of anastomotic blood flow estimation assisted by ICG imaging in laparoscopic radical resection of rectal cancer with left colic artery preservation

Zhonghua Zhang1, Yang Liu1, Weiming Mao1, Fen Chen1,(), Heng Du1   

  1. 1. Department of General Surgery,Huanggang Central Hospital,Huanggang Hubei Province 438000,China
  • Received:2021-11-11 Published:2022-12-26
  • Corresponding author: Fen Chen
  • Supported by:
    Hubei Province Science and technology planning project(2014CFC1101); 2020 General science and technology project of Huanggang City(XQYF2020000018)
引用本文:

张中华, 刘扬, 毛伟明, 陈峰, 杜恒. ICG显影技术辅助吻合口血运判断在保留左结肠动脉的腹腔镜直肠癌根治术中临床意义研究[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(06): 688-691.

Zhonghua Zhang, Yang Liu, Weiming Mao, Fen Chen, Heng Du. Clinical significance of anastomotic blood flow estimation assisted by ICG imaging in laparoscopic radical resection of rectal cancer with left colic artery preservation[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(06): 688-691.

目的

探讨ICG显影技术辅助吻合口血运判断在保留左结肠动脉的腹腔镜下全直肠系膜切除(TME)术中的临床效果。

方法

选取2018年1月至2020年12月行保留左结肠动脉的腹腔镜根治术的120例患者的临床资料。按随机数字表法分为ICG组和对照组各60例。ICG组行ICG显影技术辅助保留左结肠动脉的腹腔镜下TME术,对照组行保留左结肠动脉的腹腔镜下TME术。数据使用SPSS 20.0统计学软件进行分析,围手术期指标等计量资料采用(

xˉ
±s)表示,采用独立样本t检验;术后并发症等计数资料采用χ2检验;等级资料采用秩和检验。P<0.05为差异有统计学意义。

结果

ICG组首次肛门排气时间和住院时间均短于对照组,差异有统计学意义(P<0.05);两组手术时间、术中出血量、切除肠管长度及淋巴结请扫数目比较差异无统计学意义(P>0.05)。ICG组患者术后并发症总发生率(6.7%)低于对照组(20.0%),差异有统计学意义(P<0.05)。所有患者均获得随访,中位随访时间19个月(7~43个月),ICG组患者未出现肿瘤转移和复发,对照组出现肝转移1例,盆腔复发1例,两组患者局部复发与远处转移情况比较差异均无统计学意义(P>0.05)。

结论

ICG显影技术辅助吻合口血供判断在保留左结肠动脉的腹腔镜TME术中效果显著,可在术中通过评估目标肠管血流灌注情况,指导肠管精确切除,减少因吻合口血供不足引起吻合口漏的发生,且短期预后良好。

Objective

To investigate the clinical effect of anastomotic blood flow estimation assisted by ICG imaging in laparoscopic total mesangial resection(TME)for rectal cancer with left colic artery preservation.

Methods

The clinical data of 120 patients who underwent laparoscopic radical resection with left colic artery preservation from January 2018 to December 2020 were selected. According to the random number table method,they were divided into ICG group and control group,60 cases in each group. The ICG group underwent laparoscopic TME with left colonic artery preservation assisted by ICG imaging technology,while the control group underwent laparoscopic TME with left colonic artery preservation. Data were analyzed by SPSS 20.0 statistical software. Perioperative indicators and other measurement data were represented by(

xˉ
±s),and independent sample t test was used. Postoperative complications and other counting data were analyzed by χ2 test. Rank sum test was used for rank data. P<0.05 was considered statistically significant.

Results

The first anal exhaust time and hospital stay in ICG group were shorter than those in the control group,and the differences were statistically significant(P<0.05). There were no significant differences in operation time,intraoperative blood loss,length of resected bowel and number of lymph nodes scanned between the two groups(P>0.05). The total incidence of postoperative complications in ICG group(6.7%)was lower than that in control group(20.0%),and the difference was statistically significant(P<0.05). All patients were followed up for a median of 19 months(7~43 months). There was no tumor metastasis or recurrence in ICG group,while there was 1 case of liver metastasis and 1 case of pelvic recurrence in control group. There was no significant difference in local recurrence and distant metastasis between the two groups(P>0.05).

Conclusion

ICG imaging assisted anastomotic blood supply judgment has a significant effect in laparoscopic TME with left colic artery preservation. It can guide accurate bowel resection by evaluating the target intestinal blood perfusion during the operation,reduce the incidence of anastomotic leakage caused by insufficient anastomotic blood supply,and has a good short-term prognosis.

表1 120例保留左结肠动脉腹腔镜TME术中是否行ICG显影技术两组患者临床资料比较[(
xˉ
±s),例]
表2 120例保留左结肠动脉腹腔镜TME术中是否行ICG显影技术两组患者围手术期指标比较(
xˉ
±s)
表3 120例保留左结肠动脉腹腔镜TME术中是否行ICG显影技术两组患者术后并发症发生情况比较[例(%)]
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