吲哚菁绿-近红外显像技术在腹腔镜结直肠癌手术中的应用价值

背景与目的 淋巴结清扫和消化道重建是结直肠癌手术中需解决的重要问题，近年来吲哚菁绿（ICG）显像技术已广泛应用于临床并展现出良好前景，本研究旨在探讨吲哚菁绿-近红外（ICG-NIR）显像技术在腹腔镜结直肠癌术中的应用价值。方法 回顾性研究分析2019年7月—2020年12月中南大学湘雅三医院胃肠外科收治的行腹腔镜结直肠癌根治术的234例患者的临床病例资料，其中37例术中使用ICG-NIR显像技术（ICG组），197例行常规腹腔镜手术，术中未使用ICG荧光显像系统（非ICG组），比较两组患者一般病例资料、手术资料、术中及术后并发症等资料。结果 两组患者术前基线资料差异无统计学意义（均P>0.05）。ICG组与非ICG组平均术中出血量（87 mL vs. 98 mL）、平均手术时间（195 min vs. 220 min）、手术方式方面比较差异无统计学意义（均P>0.05），ICG组2例ICG荧光显像提示吻合口血运不佳，术中改变切缘再吻合，非ICG组无改变手术计划，两组非计划处置率差异有统计学意义（P=0.024）。ICG组与非ICG组在中位首次排气时间（3 d vs. 3 d）、中位术后住院时间（10 d vs. 10 d）、吻合口瘘发生率（2.7% vs. 5.5%）、总并发症发生率（5.4% vs. 8.1%）及平均并发症综合指数（20.03 vs. 18.16）的差异均无统计学意义（均P>0.05）。ICG组平均淋巴结检出数目高于非ICG组（17.37枚vs. 14.29枚，P=0.002），但两组在平均阳性淋巴结数目（1.40枚vs. 1.45枚）、淋巴结转移患者比例（32.4% vs. 39.5%）的差异均无统计学意义（均P>0.05）。结论 腹腔镜结直肠癌根治术中应用ICG显像技术安全可行，能指导淋巴结的清扫提升手术质量、实时评估肠管血流灌注，但其在降低吻合口瘘和总并发症的发生方面未显示出优势。

Application value of indocyanine green combined with near-infrared imaging technique in laparoscopic colorectal cancer surgery

Background and Aims Lymph node dissection and digestive tract reconstruction are important issues to be solved in colorectal cancer surgery, and indocyanine green (ICG) imaging technology has been widely used in clinical practice with good results in recent years. The purpose of this study was to investigate the application value of ICG and near-infrared fluorescent imaging (ICG-NIR) in laparoscopic colorectal cancer surgery.Methods The clinical data of 234 patients undergoing laparoscopic radical resection of colorectal cancer from July 2019 to December 2020 in the Department of Gastrointestinal Surgery of the Third Xiangya Hospital, Central South University were analyzed retrospectively. Of the patients, ICG-NIR imaging technology was used in 37 cases during operation (ICG group), and 137 cases underwent the conventional laparoscopic procedure without using ICG-NIR imaging technology (non-ICG group). The general data, surgical variables, and intraoperative and postoperative complications were compared between the two groups of patients.Results There was no significant difference in baseline data between the two groups (all P>0.05). There were no significant differences between ICG group versus the non-ICG group in terms of the average intraoperative blood loss (87 mL vs. 98 mL), average operative time (195 min vs. 220 min), and surgical procedures between the two groups (all P>0.05). In the ICG group, 2 cases underwent re-anastomosis after changing the surgical margins during operation because the ICG fluorescent imaging showed poor blood flow in the anastomosis, while no surgical plan change was made in the non-ICG group. The unplanned operation rate between the two groups had a statistical difference (P=0.024). There were no significant differences between the ICG group versus the non-ICG group in the median time to the first postoperative gas passage (3 d vs. 3 d), the median length of hospitalization (10 d vs. 10 d), the incidence rate of anastomotic leakage (2.7% vs. 5.5%), the overall incidence of complications (5.4% vs. 8.1%) and the mean comprehensive complication index (20.03 vs. 18.16) (all P>0.05). The mean number of lymph nodes detected in the ICG group was higher than that of the non-ICG group (17.37 vs. 14.29, P=0.002), but there were no statistically significant differences in the mean number of positive lymph nodes (1.40 vs. 1.45) and proportion of cases with lymph node metastasis (32.4% vs. 39.5%) between the two groups (both P>0.05).Conclusion The application of the ICG fluorescence technique in laparoscopic radical resection for colorectal cancer is safe and feasible. It can guide lymph node dissection to improve operation quality and assist in real-time evaluation of intestinal perfusion. However, it shows no advantages in reducing the incidence of anastomotic leakage and overall complications.