微创结直肠手术中预防吻合口漏的ICG-FA：荟萃分析

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-09-03 DOI:10.1016/j.jss.2025.07.051

Muhammad Imran MBBS , Shahr Yar MBBS, MRCS , Mansab Ali MBBS, FCPS, FACS , Amir Usman MBBS, FCPS, FACS , Shujaat Ali MBBS , Adeel Sarwar MBBS, MD , Shah Bano MBBS , Hala Anwar MBBS , Kashmala Anwar MBBS , Ghazala S. Virk MD , Muhammad Shehryar Hussain MBBS

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引用次数: 0

摘要

吻合口瘘是结直肠手术后的严重并发症。吲哚菁绿荧光血管造影（ICG-FA）允许实时灌注评估，并可能降低泄漏率；然而，最近较大的随机临床试验报告了相互矛盾的结果。本荟萃分析旨在阐明ICG-FA在减少微创结直肠手术后吻合口瘘及相关并发症方面的有效性。方法我们在数据库中进行了全面的检索，以确定相关研究。将检索结果导入covid - ence进行文章资格筛选，并使用RevMan 5.4在meta分析模型中使用风险比（rr）或95%置信区间（ci）的平均差异综合所有相关结局数据。CRD420251031138。结果纳入6项随机临床试验，共纳入3264名受试者。ICG-FA显著降低吻合口总漏（RR: 0.66, 95% CI [0.53-0.83], P = 0.0005）和并发症（RR: 0.88, 95% CI [0.78-0.99], P = 0.03）的风险。亚组分析显示左侧吻合口瘘发生率显著降低（RR: 0.57, 95% CI [0.44-0.75], P < 0.0001），右侧吻合口瘘发生率无显著降低（RR: 0.90, 95% CI [0.53-1.51], P = 0.68）。Clavien-Dindo≥3并发症、再手术率和住院时间无显著差异。而ICG-FA组手术时间较长（平均差异：5.57,95% CI [1.56 ~ 9.58], P = 0.006）。结论在微创结直肠手术中，sig - fa可显著减少吻合口漏及整体并发症，尤其是左侧吻合口。然而，它的使用与稍长的手术时间有关。需要进一步的研究来证实其在右侧手术和长期结果中的作用。

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ICG-FA for Anastomotic Leak Prevention During Minimally Invasive Colorectal Surgery: A Meta-analysis

Introduction

Anastomotic leakage is a serious complication after colorectal surgery. Indocyanine green fluorescence angiography (ICG-FA) allows real-time perfusion assessment and may reduce leak rates; however, recent larger randomized clinical trials reported conflicting results. This meta-analysis aimed to clarify the effectiveness of ICG-FA in reducing anastomotic leakage and related complications following minimally invasive colorectal surgery.

Methods

We conducted a comprehensive search across the databases to identify relevant studies. The search results were imported into Covidence for article eligibility screening, and all relevant outcomes data were synthesized using risk ratios (RRs) or mean differences with 95% confidence intervals (CIs) in meta-analysis models using RevMan 5.4. CRD420251031138.

Results

Six randomized clinical trials involving 3264 participants were included. ICG-FA significantly reduced the risk of overall anastomotic leakage (RR: 0.66, 95% CI [0.53-0.83], P = 0.0005) and complications (RR: 0.88, 95% CI [0.78-0.99], P = 0.03). Subgroup analysis showed a significant reduction in leakage for left-sided anastomoses (RR: 0.57, 95% CI [0.44-0.75], P < 0.0001) but not for right-sided ones (RR: 0.90, 95% CI [0.53-1.51], P = 0.68). No significant differences were found in Clavien–Dindo ≥3 complications, reoperation rates, or hospital stay. However, the ICG-FA group had a longer operation time (mean difference: 5.57, 95% CI [1.56-9.58], P = 0.006).

Conclusions

ICG-FA significantly reduces anastomotic leakage and overall complications in minimally invasive colorectal surgery, especially for left-sided anastomoses. However, its use is associated with a slightly longer operative time. Further research is needed to confirm its role in right-sided procedures and long-term outcomes.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.