BACKGROUND Assessment of anastomotic blood perfusion with intraoperative indocyanine green fluorescence angiography (ICG-FA) may be effective in preventing anastomotic leak compared with standard intraoperative methods in colorectal surgery. METHODS MEDLINE, PubMed, Cochrane Central Register of Controlled Trials and the Cochrane Library were searched for RCTs and observational studies on intraoperative ICG-FA to May 2020. Odds ratios (ORs), risk differences and mean differences (MDs) were calculated with 95 per cent c.i. based on intention-to-treat analysis. The number needed to treat for an additional beneficial outcome was also estimated. RESULTS Twenty-five comparative studies included a total of 7735 patients. The use of intraoperative ICG fluorescence angiography was linked with a significant reduction in all grades anastomotic leak (OR 0.39 (95 per cent c.i. 0.31 to 0.49), P < 0.001; number needed to treat for an additional beneficial outcome (NNTB) 23) and length of hospital stay (MD -0.72 (95 per cent c.i. -1.22 to -0.21) days, P = 0.006). A significantly lower incidence of grade A (OR 0.33 (0.18 to 0.60), P < 0.001), grade B (OR 0.58 (0.35 to 0.97), P = 0.04) and grade C (OR 0.59 (0.38 to 0.92), P = 0.02) anastomotic leak was demonstrated in favour of ICG-FA. For low or ultra-low rectal resection, the odds of developing anastomotic leakage was 0.32 (0.23 to 0.45) (P < 0.001; NNTB 14). There were no differences in duration of surgery, and no adverse events related to ICG fluorescent injection. CONCLUSION The use of ICG-FA instead of standard intraoperative methods to assess anastomosis blood perfusion in colorectal surgery leads to a significant reduction in anastomotic leakage and in the need for surgical reintervention for anastomotic leak, especially in patients with low or ultra-low rectal resections.

中文翻译：

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吲哚菁绿色荧光血管造影与标准术中预防结直肠手术吻合口漏的方法：荟萃分析。

背景技术与大肠外科手术中的标准术中方法相比，术中吲哚菁绿色荧光血管造影术（ICG-FA）评估吻合术血液灌注可能有效预防吻合口漏。方法检索MEDLINE，PubMed，对照临床试验的Cochrane中央登记册和Cochrane图书馆，以了解至2020年5月术中ICG-FA的RCT和观察性研究。计算出的赔率（OR），风险差异和平均差异（MD）为95基于意向治疗分析的分ci。还估计了治疗其他有益结果所需的数量。结果25项比较研究共纳入7735例患者。术中使用ICG荧光血管造影术可显着减少所有级别的吻合口漏（OR 0。39（95％ci 0.31至0.49），P <0.001；达到额外有益结局（NNTB）所需的治疗次数（23）和住院时间（MD -0.72（95％ci -1.22至-0.21）天，P = 0.006）。A级（OR 0.33（0.18至0.60），P <0.001），B级（OR 0.58（0.35至0.97），P = 0.04）和C级（OR 0.59（0.38至0.92），P = 0.02）吻合口吻合术被证实有利于ICG-FA。对于低位或超低位直肠切除术，发生吻合口漏的几率是0.32（0.23至0.45）（P <0.001； NNTB 14）。手术时间没有差异，也没有与ICG荧光注射有关的不良事件。