gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2019-18-4-139-150gnck-1524Research ArticleОБЗОР ЛИТЕРАТУРЫ, МЕТАНАЛИЗREVIEWМОЖЕТ ЛИ ФЛУОРИСЦЕНТНАЯ АНГИОГРАФИЯ СНИЗИТЬ ЧАСТОТУ НЕСОСТОЯТЕЛЬНОСТИ ТОЛСТОКИШЕЧНЫХ АНАСТОМОЗОВ? (мета-анализ)CAN FLUORESCENT ANGIOGRAPHY REDUCE THE LEAK RATE OF COLONIC ANASTOMOSES? (a meta-analysis)АлексеевМ. В.AlekseevM. V.

Алексеев Михаил Владимирович

ул. Саляма Адиля, д. 2, Москва, 123423

123423, Moscow, str. Salyama Adilya, 2

doctor-pro@mail.ruШелыгинЮ. А.ShelyginYu. A.

Москва

 

РыбаковЕ. Г.RybakovE. G.ФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава РоссииРоссияState Scientific Centre of Coloproctology of the Ministry of Healthcare of RussiaRussian FederationФГБУ «ГНЦК им. А.Н. Рыжих» Минздрава России; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииRussian FederationState Scientific Centre of Coloproctology of the Ministry of Healthcare of Russia; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of RussiaRussian Federation201921122019184139150Copyright © Алексеев М.В., Шелыгин Ю.А., Рыбаков Е.Г., 20192019Алексеев М.В., Шелыгин Ю.А., Рыбаков Е.Г.Alekseev M.V., Shelygin Y.A., Rybakov E.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1524ЦЕЛЬ

ЦЕЛЬ. Целью данного мета-анализа является оценка влияния флуоресцентной ангиографии (ФА) с индоцианином зеленым на снижение частоты несостоятельности колоректального анастомоза (НА).

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ. В мае 2019 года в электронной базе медицинских публикаций PubMed осуществлен поиск сравнительных исследований, посвященных флуоресцентной ангиографии в колоректальной хирургии. Первичной точкой исследований была частота несостоятельности колоректального анастомоза. Для оценки риска систематических ошибок в нерандомизированных сравнительных исследованиях была использована шкала Ньюкасл-Оттава. Отношение шансов и доверительный интервал были рассчитаны при помощи статистических инструментов для дихотомических величин с помощью метода Peto с построением Forestplot.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Всего в мета-анализ было включено 8 исследований - 2 466 пациентов, которым были проведены операции на толстой кишке с формированием межкишечного анастомоза, из них у 1218 пациентов была проведена интраоперационная методика флуоресцентной ангиографии с целью определения адекватности кровоснабжения анастомозируемых участков кишки. По данным мета-анализа выявлено статистически значимое влияние ФА на снижение частоты НА как в колоректальной хирургии – ОШ=0,58 (95% ДИ, 0,39-0,85) (P=0,006), так и в хирургии рака прямой кишки - ОШ=0,28 (95% ДИ, 0,14-0,55) (P=0,0002). Ограничением мета-анализа является включение только одного рандомизированного исследования в связи с их отсутствием.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Флуоресцентная ангиография с индоцианином зеленым является методом профилактики несостоятельности колоректального анастомоза. Результаты рандомизированных клинических исследований необходимы для подтверждения эффективности методики.

AIM

AIM: to evaluate of efficacy of fluorescence angiography (FA) in reducing the anastomotic leakage (AL) rate after colorectal surgery in meta-analysis.

SEARCH STRATEGY

SEARCH STRATEGY: PubMed were searched up to May 2019 for studies comparing fluorescence imaging with standard approach. The primary outcome measure was colorectal anastomotic leakage (AL) rate. The Newcastle-Ottawa scale was used for quality assessment. A meta-analysis with random-effects model was performed to calculate odds ratios (ORs) from the original data.

RESULTS

RESULTS: Two thousand four hundred and sixty-six patients from 7 non-randomized studies and 1 randomized study were included. Fluorescence imaging significantly reduced the AL rate in patients after colorectal surgery (OR 0.58; 95%CI 0.39-0.85; p=0.006) and after rectal cancer surgery (OR 0.28; 95%CI, 0.14-0.55; p=0.0002). A limitation of this meta-analysis is the inclusion of only one randomized study.

CONCLUSION

CONCLUSION: Fluorescence angiography with indocyanine green is a method of preventing of leakage of colorectal anastomosis. The results of randomized clinical trials are needed to confirm the effectiveness of this technique.

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The authors declare that there are no conflicts of interest present.