Background: To date, no standardized protocols nor a quantitative assessment of the near-infrared fluorescence angiography with indocyanine green (NIR-ICG) are available. The aim of this study was to evaluate the timing of fluorescence as a reproducible parameter and its efficacy in predicting anastomotic leakage (AL) in colorectal surgery. Methods: A consecutive cohort of 108 patients undergoing minimally invasive elective procedures for colorectal cancer was prospectively enrolled. The difference between macro and microperfusion (ΔT) was obtained by calculating the timing of fluorescence at the level of iliac artery division and colonic wall, respectively. Results: Subjects with a ΔT ≥ 15.5± 0.5 s had a higher tendency to develop an AL (p< 0.01). The ΔT/heart rate interaction was found to predict AL with an odds ratio of 1.02 (p< 0.01); a cut-off threshold of 832 was identified (sensitivity 0.86, specificity 0.77). Perfusion parameters were also associated with a faster bowel motility resumption and a reduced length of hospital stay. Conclusions: The analysis of the timing of fluorescence provides a quantitative, easy evaluation of tissue perfusion. A ΔT/HR interaction ≥832 may be used as a real-time parameter to guide surgical decision making in colorectal surgery.
背景：目前，吲哚菁绿近红外荧光血管造影（NIR-ICG）尚无标准化方案或定量评估方法。本研究旨在评估荧光时间作为可重复性参数的有效性，及其在结直肠手术中预测吻合口漏（AL）的效能。方法：前瞻性纳入连续108例接受微创择期结直肠癌手术的患者。通过分别计算髂动脉分叉处与结肠壁的荧光时间，获得宏观与微观灌注的时间差（ΔT）。结果：ΔT ≥ 15.5±0.5秒的患者发生AL的倾向更高（p<0.01）。研究发现ΔT/心率交互作用可预测AL，比值比为1.02（p<0.01），并确定832为截断阈值（敏感性0.86，特异性0.77）。灌注参数还与肠道功能更快恢复及住院时间缩短相关。结论：荧光时间分析为组织灌注提供了定量、简便的评估方法。ΔT/心率交互作用≥832可作为实时参数，用于指导结直肠手术中的临床决策。
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