吲哚菁绿在腹腔镜低位直肠癌术中的应用

Application of Indocyanine Green in Laparoscopic Low Rectal Cancer Surgery

摘要: 目的：探讨吲哚菁绿(ICG)荧光显像技术在腹腔镜低位直肠癌术中的应用，评估ICG在术后预防吻合口瘘的作用。方法：回顾性分析安徽医科大学第二附属医院普外科在2018年9月至2021年8月接受腹腔镜低位直肠癌根治术患者共100例，其中应用吲哚菁绿荧光显像技术病人50例(ICG组)，应用常规腹腔镜低位直肠癌根治术病人50例(对照组)；统计吻合口距离肛缘距离，预防性造瘘，吻合方式，手术时间，术中出血量，预离断肠管位置改变例数，术后腹腔感染发生率，术后住院时间，术后吻合口瘘(anastomotic leakage, AL)的发生率，及吻合口瘘导致的死亡数量等临床资料。结果：在ICG组中，预离断肠管位置改变例数明显多于对照组，且在减少术后腹腔感染、降低住院时间方面也具有一定优势(p < 0.05)；在主要观察指标术后吻合口瘘方面，ICG组仅出现4例吻合口瘘，且处于A、B级，而在我们对照组中出现13例，B、C级瘘占10例，且差异具有统计学意义(p < 0.05)。结论：吲哚菁绿在腹腔镜低位直肠癌术中的应用可见降低术后吻合口瘘的发生率。

Abstract: Objective: To explore the application of indocyanine green (ICG) fluorescence imaging technology in laparoscopic low rectal cancer surgery, and to evaluate the effect of ICG in preventing anastomotic leakage after surgery. Methods: A total of 100 patients who underwent laparoscopic low rectal can-cer radical resection from September 2018 to August 2021 in the General Department of the Sec-ond Affiliated Hospital of Anhui Medical University were retrospectively analyzed, of which 50 pa-tients were treated with indocyanine green fluorescence imaging (ICG group), 50 patients with conventional laparoscopic low-position rectal cancer resection (control group); the distance be-tween anastomotic stoma and anal verge, prophylactic fistula, anastomosis method, operation time, intraoperative blood loss, and changes in the position of pre-disconnected bowel canal were counted. The number of cases, the incidence of postoperative intra-abdominal infection, postoperative hos-pital stay, the incidence of postoperative anastomotic leakage (AL), and the number of deaths caused by anastomotic leakage and other clinical data. Results: In the ICG group, the number of cases with changes in the position of the predisconnected bowel tube was significantly more than that in the control group, and it also had certain advantages in reducing postoperative abdominal infection and hospitalization time (p < 0.05); the main observation index was postoperative anas-tomotic leakage. There were only 4 cases of anastomotic leakage in the ICG group, and they were in grades A and B, while 13 cases occurred in our control group, and 10 cases were in grades B and C, and the difference was statistically significant (p < 0.05). Conclusion: The application of indocyanine green in laparoscopic low rectal cancer can reduce the incidence of postoperative anastomotic leakage.