PDF(Pubmed)
Abstract：
Intraoperative indocyanine green fluorescence angiography (ICG-FA) may be of added value during pouch surgery, in particular after vascular ligations as lengthening maneuver. The aim was to determine quantitative perfusion parameters within the efferent/afferent loop and explore the impact of vascular ligation. Perfusion parameters were also compared in patients with and without anastomotic leakage (AL).
All consenting patients that underwent FA-guided ileal pouch-anal anastomosis (IPAA) between July 2020 and December 2021 were included. After intravenous bolus injection of 0.1 mg/kg ICG, the near-infrared camera (Stryker Aim 1688) registered the fluorescence intensity over time. Quantitative analysis of ICG-FA from standardized regions of interests on the pouch was performed using software. Fluorescence parameters were extracted for inflow (T0, Tmax, Fmax, slope, Time-to-peak) and outflow (T90% and T80%). Change of management related to FA findings and AL rates were recorded.
Twenty-one patients were included, three patients (14%) required vascular ligation to obtain additional length, by ligating terminal ileal branches in two and the ileocolic artery (ICA) in one patient. In nine patients the ICA was already ligated during subtotal colectomy. ICG-FA triggered a change of management in 19% of patients (n = 4/21), all of them had impaired vascular supply (ligated ileocolic/ terminal ileal branches). Overall, patients with intact vascular supply had similar perfusion patterns for the afferent and efferent loop. Pouches with ICA ligation had longer Tmax in both afferent as efferent loop than pouches with intact ICA (afferent 51 and efferent 53 versus 41 and 43 s respectively). Mean slope of the efferent loop diminished in ICA ligated patients 1.5(IQR 0.8-4.4) versus 2.2 (1.3-3.6) in ICA intact patients.
Quantitative analysis of ICG-FA perfusion during IPAA is feasible and reflects the ligation of the supplying vessels.
All consenting patients that underwent FA-guided ileal pouch-anal anastomosis (IPAA) between July 2020 and December 2021 were included. After intravenous bolus injection of 0.1 mg/kg ICG, the near-infrared camera (Stryker Aim 1688) registered the fluorescence intensity over time. Quantitative analysis of ICG-FA from standardized regions of interests on the pouch was performed using software. Fluorescence parameters were extracted for inflow (T0, Tmax, Fmax, slope, Time-to-peak) and outflow (T90% and T80%). Change of management related to FA findings and AL rates were recorded.
Twenty-one patients were included, three patients (14%) required vascular ligation to obtain additional length, by ligating terminal ileal branches in two and the ileocolic artery (ICA) in one patient. In nine patients the ICA was already ligated during subtotal colectomy. ICG-FA triggered a change of management in 19% of patients (n = 4/21), all of them had impaired vascular supply (ligated ileocolic/ terminal ileal branches). Overall, patients with intact vascular supply had similar perfusion patterns for the afferent and efferent loop. Pouches with ICA ligation had longer Tmax in both afferent as efferent loop than pouches with intact ICA (afferent 51 and efferent 53 versus 41 and 43 s respectively). Mean slope of the efferent loop diminished in ICA ligated patients 1.5(IQR 0.8-4.4) versus 2.2 (1.3-3.6) in ICA intact patients.
Quantitative analysis of ICG-FA perfusion during IPAA is feasible and reflects the ligation of the supplying vessels.
摘要：
背景：术中吲哚菁绿荧光血管造影术（ICG-FA）在囊袋手术中可能具有附加价值，特别是在血管结扎后作为加长动作。目的是确定传出/传入回路内的定量灌注参数，并探索血管结扎的影响。还比较了有和没有吻合口漏（AL）的患者的灌注参数。
方法：纳入所有在2020年7月至2021年12月期间接受FA引导回肠袋-肛门吻合术（IPAA）的患者。静脉推注0.1mg/kgICG后，近红外摄像机（StrykerAim1688）记录了荧光强度随时间的变化。使用软件对来自小袋上的标准化感兴趣区域的ICG-FA进行定量分析。提取流入的荧光参数(T0，Tmax，Fmax,斜坡,达到峰值的时间）和流出（T90%和T80%）。记录与FA结果和AL率相关的管理变化。
结果：包括21名患者，三名患者（14%）需要血管结扎以获得额外的长度，通过结扎两个末端回肠分支和一名患者的回肠动脉（ICA）。在9例患者中，ICA已在结肠次全切除术中结扎。ICG-FA在19％的患者中引发了管理变更（n=4/21），他们都有受损的血管供应（结扎回肠/回肠末端分支）。总的来说,血管供应完整的患者的传入和传出环路的灌注模式相似.与具有完整ICA的小袋相比，具有ICA结扎的小袋在作为传出环路的传入中均具有更长的Tmax（分别为传入51和传出53对41和43s）。ICA结扎患者的传出环路的平均斜率降低了1.5（IQR0.8-4.4），而ICA完整患者的平均斜率为2.2（1.3-3.6）。
结论：IPAA期间ICG-FA灌注的定量分析是可行的，反映了供应血管的结扎。
方法：纳入所有在2020年7月至2021年12月期间接受FA引导回肠袋-肛门吻合术（IPAA）的患者。静脉推注0.1mg/kgICG后，近红外摄像机（StrykerAim1688）记录了荧光强度随时间的变化。使用软件对来自小袋上的标准化感兴趣区域的ICG-FA进行定量分析。提取流入的荧光参数(T0，Tmax，Fmax,斜坡,达到峰值的时间）和流出（T90%和T80%）。记录与FA结果和AL率相关的管理变化。
结果：包括21名患者，三名患者（14%）需要血管结扎以获得额外的长度，通过结扎两个末端回肠分支和一名患者的回肠动脉（ICA）。在9例患者中，ICA已在结肠次全切除术中结扎。ICG-FA在19％的患者中引发了管理变更（n=4/21），他们都有受损的血管供应（结扎回肠/回肠末端分支）。总的来说,血管供应完整的患者的传入和传出环路的灌注模式相似.与具有完整ICA的小袋相比，具有ICA结扎的小袋在作为传出环路的传入中均具有更长的Tmax（分别为传入51和传出53对41和43s）。ICA结扎患者的传出环路的平均斜率降低了1.5（IQR0.8-4.4），而ICA完整患者的平均斜率为2.2（1.3-3.6）。
结论：IPAA期间ICG-FA灌注的定量分析是可行的，反映了供应血管的结扎。
