结直肠肛门外科2025，Vol.31Issue(2)：143-144,2.DOI:10.19668/j.cnki.issn1674-0491.2025.02.011
[评论]低位结扎对直肠癌微创手术中肠道血流灌注及吻合口漏的影响:一项随机对照试验的事后分析
Impact of low ligation on bowel perfusion and anastomotic leakage in minimally invasive rectal cancer surgery:a post hoc analysis of a randomized controlled trial
邱先达 1陈致奋1
作者信息
- 1. 福建医科大学附属协和医院结直肠外科 福建 福州 350001
- 折叠
摘要
Abstract
Background Whether the level of the inferior mesenteric artery ligation affects the incidence of anastomotic leakage remains unclear.Objective To assess the impact of the level of inferior mesenteric artery ligation on the blood flow to the anastomotic site and the incidence of anastomotic leakage using indocyanine green fluorescence imaging.De-sign A post hoc analysis of EssentiAL trial.Settings This study was conducted at 41 tertiary referral centers in Japan.Patients 839 rectal cancer patients(＜12 cm from the anal verge).Main outcome measures The incidence of anasto-motic leakage and perfusion status were compared between the high and low ligation groups.Results The median fluo-rescence time was similar at 25 seconds in both groups(P=0.74).Although no statistical difference was noted,the high ligation group was more likely to have greater outliers in fluorescence time compared to the low ligation group.The high ligation group demonstrated higher poor perfusion rates than the low ligation group(2.8％vs.1.5％,P=0.52).In the high ligation group,anastomotic leakage occurred in one case of poor perfusion where additional resection was not performed by the surgeon's intraoperative judgment.Additionally,the additional resection rate nearly doubled with the use of indocyanine green fluorescence imaging.After propensity score matching(129 patients per group),the overall anastomotic leakage rate was 13.2％in the high ligation group and 10.9％in the low ligation group(P=0.57).Limita-tions This study was a post hoc analysis,the sample size was small,and the anastomosis methods varied.Conclusions The level of inferior mesenteric artery ligation did not affect blood flow at the anastomotic site or the incidence of anas-tomotic leakage statistically,but assessing bowel perfusion using indocyanine green fluorescence imaging can offer clinical benefits,optimizing patient outcomes.Trial registration The Japan Registry of Clinical Trials(jRCTs-CRB3180007),the Japa-nese Clinical Trials Registry(UMIN-CTR000030240).关键词
直肠癌/吲哚菁绿荧光成像技术/吻合口漏/肠系膜下动脉/结扎Key words
rectal cancer/Indocyanine green fluorescence imaging/anastomotic leakage/inferior mesenteric artery/ligation分类
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邱先达,陈致奋..[评论]低位结扎对直肠癌微创手术中肠道血流灌注及吻合口漏的影响:一项随机对照试验的事后分析[J].结直肠肛门外科,2025,31(2):143-144,2.
