Objective: To examine the safety and feasibility of using fusion indocyanine green fluorescence imaging (FIGFI) technique for intraoperative evaluation of colorectal perfusion in the totally laparoscopic left colectomy. Methods: A retrospective cohort study was conducted to collect the clinical data of 58 patients with left colon cancer who underwent totally laparoscopic surgery at the Colorectal Surgery Department, Cancer Hospital, Chinese Academy of Medical Sciences from October 2016 to December 2019. There were 39 males and 19 females, aging (57.0±10.1)years(range:28 to 75 years). According to whether the FIGFI was used during the operation, they were divided into 36 cases in the study group and 22 cases in the control group. The clinical pathological characteristics, operative and postoperative recovery of the two groups were compared by t test, χ2 test, and Fisher exact test. Results: All the 58 patients underwent R0 resection with totally laparoscopic surgery. In the study group, due to poor bowel blood flow after cutting the mesentery (Sherwinter score = 1), 1 patient had to be expanded the resection range until the blood flow was rich(Sherwinter score≥3), and 1 patient in the control group had the complication of postoperative anastomotic leakage of grade A. Compared with the control group, the operation time in the study group was shorter ((156.3±43.5) minutes vs. (180.4±41.3) minutes, t=-2.083, P=0.042). However, there were no significant differences in the amount of blood loss, postoperative hospital stay, postoperative time of anal exhaust, length of bowel resection, number of lymph nodes dissected, and in the incidence of postoperative complications between the two groups. Median follow-up period was 23 months (range: 18 to 37 months). There were no long-term postoperative complications such as ischemic enteritis and anastomotic stenosis in both groups. Conclusions: The FIGFI is safe and feasible to assess the blood supply of intestinal segment and anastomosis during totally laparoscopic left hemicolectomy, and is easy to operate. It is expected to reduce the incidence of anastomotic leakage.
目的： 探讨在完全腹腔镜左半结肠切除术中使用吲哚菁绿荧光成像（FIGFI）对肠管血流灌注进行评估的安全性和可行性。 方法： 回顾性分析2016年10月至2019年12月在中国医学科学院肿瘤医院接受腹腔镜手术的58例左半结肠癌患者的资料。男性39例，女性19例，年龄（57.0±10.1）岁（范围：28~75岁）。根据术中是否使用FIGFI分为研究组（36例）和对照组（22例）。采用t检验、χ²检验、Fisher确切概率法比较两组患者的临床病理学特征、手术及术后恢复情况。 结果： 58例患者均完成完全腹腔镜手术。研究组1例患者因裁剪系膜后出现肠管血运欠佳（Sherwinter评分1分）而扩大切除范围直至肠管血运良好（Sherwinter评分≥3分），对照组1例发生术后吻合口漏（A级并发症）。研究组手术时间短于对照组［（156.3±43.5）min比（180.4±41.3）min，t=-2.083，P=0.042］，两组术中出血量、术后排气时间、术后住院时间、切除肠管长度、淋巴结清扫数目、术后并发症发生率的差异均无统计学意义。中位随访时间23个月（范围：18~37个月），两组患者均未发生缺血性肠炎及吻合口狭窄等远期术后并发症。 结论： FIGFI评估完全腹腔镜左半结肠切除术吻合口及肠段血供安全可行，操作方便，有望降低吻合口漏的发生率。.