PDF(Pubmed)
Abstract：
BACKGROUND: Ureteric injury (UI) is an infrequent but serious complication of colorectal surgery. Prophylactic ureteric stenting is employed to avoid UI, yet its efficacy remains debated. Intraoperative indocyanine green fluorescence imaging (ICG-FI) has been used to facilitate ureter detection. This study aimed to investigate the role of ICG-FI in identification of ureters during colorectal surgery and its impact on the incidence of UI.
METHODS: A retrospective cohort study involving 556 consecutive patients who underwent colorectal surgery between 2018 and 2023 assessed the utility of routine prophylactic ureteric stenting with adjunctive ICG-FI. Patients with ICG-FI were compared to those without ICG-FI. Demographic data, operative details, and postoperative morbidity were analyzed. Statistical analysis included univariable regression.
RESULTS: Ureteric ICG-FI was used in 312 (56.1%) patients, whereas 43.9% were controls. Both groups were comparable in terms of demographics except for a higher prevalence of prior abdominal surgeries in the ICG-FI group. Although intraoperative visualization was significantly higher in the ICG-FI group (95.3% vs 89.1%; p = 0.011), the incidence of UI was similar between groups (0.3% vs 0.8%; p = 0.585). Postoperative complications were similar between the two groups. Median stent insertion time was longer in the ICG-FI group (32 vs 25 min; p = 0.001).
CONCLUSIONS: Ureteric ICG-FI improved intraoperative visualization of the ureters but was not associated with a reduced UI rate. Median stent insertion time increased with use of ureteric ICG-FI, but total operative time did not. Despite its limitations, this study is the largest of its kind suggesting that ureteric ICG-FI may be a valuable adjunct to facilitate ureteric visualization during colorectal surgery.
METHODS: A retrospective cohort study involving 556 consecutive patients who underwent colorectal surgery between 2018 and 2023 assessed the utility of routine prophylactic ureteric stenting with adjunctive ICG-FI. Patients with ICG-FI were compared to those without ICG-FI. Demographic data, operative details, and postoperative morbidity were analyzed. Statistical analysis included univariable regression.
RESULTS: Ureteric ICG-FI was used in 312 (56.1%) patients, whereas 43.9% were controls. Both groups were comparable in terms of demographics except for a higher prevalence of prior abdominal surgeries in the ICG-FI group. Although intraoperative visualization was significantly higher in the ICG-FI group (95.3% vs 89.1%; p = 0.011), the incidence of UI was similar between groups (0.3% vs 0.8%; p = 0.585). Postoperative complications were similar between the two groups. Median stent insertion time was longer in the ICG-FI group (32 vs 25 min; p = 0.001).
CONCLUSIONS: Ureteric ICG-FI improved intraoperative visualization of the ureters but was not associated with a reduced UI rate. Median stent insertion time increased with use of ureteric ICG-FI, but total operative time did not. Despite its limitations, this study is the largest of its kind suggesting that ureteric ICG-FI may be a valuable adjunct to facilitate ureteric visualization during colorectal surgery.
摘要：
背景：输尿管损伤（UI）是结直肠手术的一种罕见但严重的并发症。预防性输尿管支架置入术用于避免UI，然而，其功效仍有争议。术中吲哚菁绿荧光成像（ICG-FI）已用于促进输尿管检测。本研究旨在探讨ICG-FI在结直肠手术中输尿管识别中的作用及其对UI发生率的影响。
方法：一项回顾性队列研究，包括2018年至2023年期间接受结直肠手术的556例连续患者，评估了常规预防性输尿管支架置入术辅助ICG-FI的实用性。将具有ICG-FI的患者与没有ICG-FI的患者进行比较。人口统计数据,操作细节,并对术后发病率进行分析。统计分析包括单变量回归。
结果：312例（56.1%）患者使用输尿管ICG-FI，而43.9%是对照。除了ICG-FI组中先前腹部手术的患病率较高之外，两组在人口统计学方面具有可比性。尽管ICG-FI组的术中可视化明显更高（95.3％vs89.1％；p=0.011），组间UI的发生率相似(0.3%vs0.8%;p=0.585).两组术后并发症情况相似。ICG-FI组的中位支架插入时间更长（32对25分钟；p=0.001）。
结论：输尿管ICG-FI改善了术中输尿管的可视化，但与降低的UI率无关。使用输尿管ICG-FI，支架插入时间中位数增加，但总手术时间没有。尽管有其局限性,这项研究是同类研究中规模最大的,提示输尿管ICG-FI可能是促进结直肠手术中输尿管可视化的有价值的辅助手段.
方法：一项回顾性队列研究，包括2018年至2023年期间接受结直肠手术的556例连续患者，评估了常规预防性输尿管支架置入术辅助ICG-FI的实用性。将具有ICG-FI的患者与没有ICG-FI的患者进行比较。人口统计数据,操作细节,并对术后发病率进行分析。统计分析包括单变量回归。
结果：312例（56.1%）患者使用输尿管ICG-FI，而43.9%是对照。除了ICG-FI组中先前腹部手术的患病率较高之外，两组在人口统计学方面具有可比性。尽管ICG-FI组的术中可视化明显更高（95.3％vs89.1％；p=0.011），组间UI的发生率相似(0.3%vs0.8%;p=0.585).两组术后并发症情况相似。ICG-FI组的中位支架插入时间更长（32对25分钟；p=0.001）。
结论：输尿管ICG-FI改善了术中输尿管的可视化，但与降低的UI率无关。使用输尿管ICG-FI，支架插入时间中位数增加，但总手术时间没有。尽管有其局限性,这项研究是同类研究中规模最大的,提示输尿管ICG-FI可能是促进结直肠手术中输尿管可视化的有价值的辅助手段.
