■吻合口漏是直肠癌切除术后的严重并发症。术中使用吲哚菁绿荧光血管造影(ICGFA)有助于预防吻合口漏,但是它的使用是有争议的。我们进行了系统评价和荟萃分析,以确定ICGFA在减少吻合口漏方面的功效。
■直到2022年9月30日发布的相关数据和研究是从PubMed检索的,Embase,和Cochrane图书馆数据库,比较ICGFA与标准治疗方法在直肠癌切除术后吻合口瘘发生率的差异。
■这项荟萃分析包括22项研究,共4,738名患者。结果表明,术中使用ICGFA降低了直肠癌术后吻合口漏的发生率[风险比(RR)=0.46;95%置信区间(95%CI),0.39-0.56;p<0.001]。同时,在不同地区的亚组分析中,发现ICGFA在亚洲(RR=0.33;95%CI,0.23-0.48;p<0.00001)和欧洲(RR=0.38;95%CI,0.27-0.53;p<0.00001)用于降低直肠癌手术后吻合口漏的发生率,但在北美却没有(RR=0.72;95%CI,0.40-1.29;p=0.27)。对于不同程度的吻合口漏,ICGFA降低了术后A型吻合口漏的发生率(RR=0.25;95%CI,0.14-0.44;p<0.00001),但并未降低B型(RR=0.70;95%CI,0.38-1.31;p=0.27)和C型(RR=0.97;95%CI,0.51-1.97;p=0.93)吻合口漏的发生率。
■ICGFA与直肠癌切除术后吻合口漏的减少有关。然而,需要更大样本量的多中心随机对照试验进行进一步验证.
UNASSIGNED: Anastomotic leakage is a serious complication after rectal cancer resection. Intraoperative use of indocyanine green fluorescence angiography (ICGFA) can help prevent anastomotic leakage, but its use is controversial. We conducted a systematic
review and meta-analysis to determine the efficacy of ICGFA in reducing anastomotic leakage.
UNASSIGNED: Relevant data and research published until September 30, 2022, was retrieved from the PubMed, Embase, and Cochrane Library databases, and the difference in the incidence of anastomotic leakage after rectal cancer resection between ICGFA and standard treatment was compared.
UNASSIGNED: This meta-analysis included 22 studies with a total of 4,738 patients. The results showed that ICGFA use during surgery decreased the incidence of anastomotic leakage after rectal cancer surgery [risk ratio (RR) = 0.46; 95% confidence interval (95% CI), 0.39-0.56; p < 0.001]. Simultaneously, in subgroup analyses for different regions, ICGFA was found to be used to reduce the incidence of anastomotic leakage after rectal cancer surgery in Asia (RR = 0.33; 95% CI, 0.23-0.48; p < 0.00001) and Europe (RR = 0.38; 95% CI, 0.27-0.53; p < 0.00001) but not in North America (RR = 0.72; 95% CI, 0.40-1.29; p = 0.27). Regarding different levels of anastomotic leakage, ICGFA reduced the incidence of postoperative type A anastomotic leakage (RR = 0.25; 95% CI, 0.14-0.44; p < 0.00001) but did not reduce the incidence of type B (RR = 0.70; 95% CI, 0.38-1.31; p = 0.27) and type C (RR = 0.97; 95% CI, 0.51-1.97; p = 0.93) anastomotic leakages.
UNASSIGNED: ICGFA has been linked to a reduction in anastomotic leakage after rectal cancer resection. However, multicenter randomized controlled trials with larger sample sizes are required for further validation.