nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-234-2-154-162nogr-3081Research ArticleЭКСПЕРИМЕНТАЛЬНАЯ ГАСТРОЭНТЕРОЛОГИЯEXPERIMENTAL GASTROENTEROLOGYМетодика количественного флуоресцентного анализа с применением индоцианина зеленого в ранней диагностике острой ишемии тонкой кишки: экспериментальное исследованиеQuantitative Fluorescence Assay Using Indocyanine Green in Early Diagnosis of Acute Small Intestinal Ischemia: An Experimental StudyШемиловР. Р.ShemilovR. R.noemail@neicon.ruhttps://orcid.org/0000-0003-3454-4690КорнюшинО. В.KornyushinO. V.o.kornyushin@gmail.comhttps://orcid.org/0000-0003-1705-7217СонинД. Л.SoninD. L.noemail@neicon.ruhttps://orcid.org/0000-0003-4600-865XНаседкинД. Б.NasedkinD. B.noemail@neicon.ruhttps://orcid.org/0009-0007-6696-7897ДаниловаЕ. С.DanilovaE. S.noemail@neicon.ruhttps://orcid.org/0000-0002-4874-0564СтруйА. В.StruiA. V.noemail@neicon.ruЖуравскийС. Г.ZhuravskyS. G.noemail@neicon.ruhttps://orcid.org/0000-0003-1629-7868ТороповаЯ. Г.ToropovaYa. G.noemail@neicon.ruhttps://orcid.org/0000-0002-6462-9022ПапаянГ. В.PapayanG. V.noemail@neicon.ruhttps://orcid.org/0000-0001-9540-7812ДаниловИ. Н.DanilovI. N.noemail@neicon.ruhttps://orcid.org/0000-0001-5129-9944ГалагудзаМ. М.GalagudzaM. M.noemail@neicon.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава РоссииРоссияAlmazov National Medical Research Centre of the Ministry of Health of the Russian FederationRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава России; Федеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет им. академика И.П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research Centre of the Ministry of Health of the Russian Federation; Pavlov First St. Petersburg State Medical UniversityRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет им. академика И.П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияPavlov First St. Petersburg State Medical UniversityRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава России; Федеральное государственное бюджетное учреждение науки Институт аналитического приборостроения Российской академии наукРоссияAlmazov National Medical Research Centre of the Ministry of Health of the Russian Federation; Institute for Analytical Instrumentation of the Russian Academy of SciencesRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава России; Федеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет им. академика И.П. Павлова» Министерства здравоохранения Российской Федерации; Федеральное государственное бюджетное учреждение науки Институт аналитического приборостроения Российской академии наукРоссияAlmazov National Medical Research Centre of the Ministry of Health of the Russian Federation; Pavlov First St. Petersburg State Medical University; Institute for Analytical Instrumentation of the Russian Academy of SciencesRussian Federation20253108202502154162Copyright © Шемилов Р.Р., Корнюшин О.В., Сонин Д.Л., Наседкин Д.Б., Данилова Е.С., Струй А.В., Журавский С.Г., Торопова Я.Г., Папаян Г.В., Данилов И.Н., Галагудза М.М., 20252025Шемилов Р.Р., Корнюшин О.В., Сонин Д.Л., Наседкин Д.Б., Данилова Е.С., Струй А.В., Журавский С.Г., Торопова Я.Г., Папаян Г.В., Данилов И.Н., Галагудза М.М.Shemilov R.R., Kornyushin O.V., Sonin D.L., Nasedkin D.B., Danilova E.S., Strui A.V., Zhuravsky S.G., Toropova Y.G., Papayan G.V., Danilov I.N., Galagudza M.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/3081

Интраоперационная оценка жизнеспособности тканей полых органов ЖКТ во время хирургических вмешательств при острой мезентериальной ишемии и целого ряда других хирургических операциях остаётся нерешённой проблемой. Существующие способы определения границ жизнеспособности тканей в условиях острого нарушения кровоснабжения характеризуются низкой степень чувствительности, что усложняет выбор тактики хирургического лечения пациента. Целью работы была оценка эффективности методики интраоперационной флуоресцентной визуализации ишемических изменений стенки кишки с использованием нового устройства «MMC Scope ICG», позволяющего использовать V/Q-ICG метод исследования для проведения количественной ангиографии c индоцианином зелёным (ICG), выполняемой в ближнем инфракрасном диапазоне. Крысы стока Вистар были разделены на четыре группы: 1) 15-минутная, 2) 30-минутная, 3) 45-минутная и 4) 60-минутная ишемия кишки, которым через 30 минут реперфузии проведены записи кривых изменений во времени яркости ICG-флуоресценции в зонах с ишемическим и реперфузионным повреждением ткани кишки в сравнении с контрольными участками здоровой кишки. Сопоставление выраженности изменений, указанных динамических кривых с типовыми морфологическими изменениями в образцах кишки крыс позволило определить прямую положительную связь между характером изменений ICG-флуоресценций и выраженностью морфологических изменений повреждённого участка кишечника.

Intraoperative assessment of tissue viability of hollow organs of the gastrointestinal tract during surgical interventions for acute mesenteric ischemia and a number of other surgical operations remains an unsolved problem. Existing methods for determining tissue viability limits in conditions of acute circulatory failure are characterized by a low sensitivity, which determines the choice of surgical treatment tactics for the patient. The aim of the work was to assess the effectiveness of the intraoperative fluorescence visualization technique for ischemic changes in the intestinal wall using a new device “MMC Scope ICG”, which allows using the V / Q-ICG method of research for quantitative angiography with indocyanine green (ICG), performed in the near infrared range. Wistar rats were divided into four groups: 1) 15-minute, 2) 30-minute, 3) 45-minute and 4) 60-minute intestinal ischemia, which after 30 minutes of reperfusion underwent recordings of curves of changes in time of ICG fluorescence brightness in zones with ischemic and reperfusion damage of intestinal tissue in comparison with control areas of healthy intestine. The analysis of relationship between changes in the indicated dynamic curves of indocyanine green fluorescence intensity and typical morphological changes in rat intestinal samples shows direct (positive) relationship between the dynamics of the increase in indocyanine green fluorescence intensity and the degree of morphological changes in the damaged area of the intestine

острая мезентериальная ишемияинфаркт кишечникафлуоресценция в ближнем инфракрасном диапазонеиндоцианин зеленыйacute mesenteric ischemiabowel infarctionnear-infrared fluorescenceindocyanine greenReferencesAcosta S. Mesenteric ischemia. Curr Opin Crit Care. 2015;21(2):171-178. doi: 10.1097/MCC.0000000000000189.Acosta S. Mesenteric ischemia. Curr Opin Crit Care. 2015;21(2):171-178. doi: 10.1097/MCC.0000000000000189.Clair D.G., Beach J.M. Mesenteric Ischemia. N Engl J Med. 2016;10;374(10):959-68. doi: 10.1056/NEJMra1503884.Clair D.G., Beach J.M. Mesenteric Ischemia. N Engl J Med. 2016;10;374(10):959-68. doi: 10.1056/NEJMra1503884.Bala M., Catena F., Kashuk J. et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2022;19;17(1):54. doi: 10.1186/s13017-022-00443-x.Bala M., Catena F., Kashuk J. et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2022;19;17(1):54. doi: 10.1186/s13017-022-00443-x.Yu H., Kirkpatrick I.D.C. An Update on Acute Mesenteric Ischemia. Can Assoc Radiol J. 2023;74(1):160-171. doi: 10.1177/08465371221094280.Yu H., Kirkpatrick I.D.C. An Update on Acute Mesenteric Ischemia. Can Assoc Radiol J. 2023;74(1):160-171. doi: 10.1177/08465371221094280.Urbanavičius L., Pattyn P., de Putte D.V., Venskutonis D. How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg. 2011; May 27;3(5):59-69. doi: 10.4240/wjgs.v3.i5.59.Urbanavičius L., Pattyn P., de Putte D.V., Venskutonis D. How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg. 2011; May 27;3(5):59-69. doi: 10.4240/wjgs.v3.i5.59.Desmettre T., Devoisselle J.M., Morton S. Fluorescence Properties and Metabolic Features of Indocyanine Green (ICG) as Related to Angiography. Survey of ophthalmology. 2000;45(1):15-27 doi: 10.1016/S0039-6257(00)00123-5.Desmettre T., Devoisselle J.M., Morton S. Fluorescence Properties and Metabolic Features of Indocyanine Green (ICG) as Related to Angiography. Survey of ophthalmology. 2000;45(1):15-27 doi: 10.1016/S0039-6257(00)00123-5.Rubben A., Eren S., Krein R. at al. Infrared videoangiofluorography of the skin with indocyanine green - rat random cutaneous flap model and results in man. Microvasc Res. 1994;47(2):240-251. doi: 10.1006/mvre.1994.1018.Rubben A., Eren S., Krein R. at al. Infrared videoangiofluorography of the skin with indocyanine green - rat random cutaneous flap model and results in man. Microvasc Res. 1994;47(2):240-251. doi: 10.1006/mvre.1994.1018.Mizukami A., Furuya S., Takiguchi K. et al.Intraoperative indocyanine green fluorescence for precise resection of nonocclusive mesenteric ischemia: a case report and diagnostic considerations based on pathology findings. Surg Case Rep. 2024;4;10(1):230. doi: 10.1186/s40792-024-02024-3.Mizukami A., Furuya S., Takiguchi K. et al.Intraoperative indocyanine green fluorescence for precise resection of nonocclusive mesenteric ischemia: a case report and diagnostic considerations based on pathology findings. Surg Case Rep. 2024;4;10(1):230. doi: 10.1186/s40792-024-02024-3.Miyashita R., Kitazawa M., Tokumaru S. Importance of intraoperative indocyanine green imaging in the management of non-occlusive mesenteric ischemia: a case report. Surg Case Rep. 2023;27;9(1):31. doi: 10.1186/s40792-023-01614-x.Miyashita R., Kitazawa M., Tokumaru S. Importance of intraoperative indocyanine green imaging in the management of non-occlusive mesenteric ischemia: a case report. Surg Case Rep. 2023;27;9(1):31. doi: 10.1186/s40792-023-01614-x.Nakagawa Y., Kobayashi K., Kuwabara S. at al. Use of indocyanine green fluorescence imaging to determine the area of bowel resection in non-occlusive mesenteric ischemia: A case report.Int J Surg Case Rep. 2018;51:352-357. doi: 10.1016/j.ijscr.2018.09.024.Nakagawa Y., Kobayashi K., Kuwabara S. at al. Use of indocyanine green fluorescence imaging to determine the area of bowel resection in non-occlusive mesenteric ischemia: A case report.Int J Surg Case Rep. 2018;51:352-357. doi: 10.1016/j.ijscr.2018.09.024.Irie T., Matsutani T., Hagiwara N., Nomura T. Successful treatment of non-occlusive mesenteric ischemia with indocyanine green fluorescence and open-abdomen management. Clin J Gastroenterol. 2017;10(6):514-518. doi: 10.1007/s12328-017-0779-3.Irie T., Matsutani T., Hagiwara N., Nomura T. Successful treatment of non-occlusive mesenteric ischemia with indocyanine green fluorescence and open-abdomen management. Clin J Gastroenterol. 2017;10(6):514-518. doi: 10.1007/s12328-017-0779-3.Khalaf M.H., Abdelrahman H., El-Menyar A. at al. Utility of indocyanine green fluorescent dye in emergency general surgery: a review of the contemporary literature. Front Surg. 2024;14;11:1345831. doi: 10.3389/fsurg.2024.1345831.Khalaf M.H., Abdelrahman H., El-Menyar A. at al. Utility of indocyanine green fluorescent dye in emergency general surgery: a review of the contemporary literature. Front Surg. 2024;14;11:1345831. doi: 10.3389/fsurg.2024.1345831.Fransvea P., Fico V., Puccioni C. at al. Application of fluorescence-guided surgery in the acute care setting: a systematic literature review. Langenbecks Arch Surg. 2023;25;408(1):375. doi: 10.1007/s00423-023-03109-7.Fransvea P., Fico V., Puccioni C. at al. Application of fluorescence-guided surgery in the acute care setting: a systematic literature review. Langenbecks Arch Surg. 2023;25;408(1):375. doi: 10.1007/s00423-023-03109-7.Gioux S., Choi H.S., Frangioni J.V. Image-guided surgery using invisible near-infrared light: fundamentals of clinical translation. Mol Imaging. 2010;9(5):237-55. PMID: 20868625.Gioux S., Choi H.S., Frangioni J.V. Image-guided surgery using invisible near-infrared light: fundamentals of clinical translation. Mol Imaging. 2010;9(5):237-55. PMID: 20868625.Kudszus S., Roesel C., Schachtrupp A., Höer J.J.Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbecks Arch Surg. 2010;395(8):1025-30. doi: 10.1007/s00423-010-0699-x.Kudszus S., Roesel C., Schachtrupp A., Höer J.J.Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbecks Arch Surg. 2010;395(8):1025-30. doi: 10.1007/s00423-010-0699-x.Nerup N., Preisler L., Svendsen M.B. et al. Quantification of fluorescence angiography in a porcine model. Langenbeck’s Arch Surg 2017;402(4):655-662. doi: 10.1007/s00423-016-1531-z.Nerup N., Preisler L., Svendsen M.B. et al. Quantification of fluorescence angiography in a porcine model. Langenbeck’s Arch Surg 2017;402(4):655-662. doi: 10.1007/s00423-016-1531-z.Degett T.H., Andersen H.S., Gogenur I. Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbeck’s Arch Surg. 2016;401(6):767-75. doi: 10.1007/s00423-016-1400-9.Degett T.H., Andersen H.S., Gogenur I. Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbeck’s Arch Surg. 2016;401(6):767-75. doi: 10.1007/s00423-016-1400-9.Jansen S.M., de Bruin D.M., van Berge Henegouwen M.I. et al. Optical techniques for perfusion monitoring of the gastric tube after esophagectomy: a review of technologies and thresholds. Dis Esophagus. 2018;1;31(6). doi: 10.1093/dote/dox161.Jansen S.M., de Bruin D.M., van Berge Henegouwen M.I. et al. Optical techniques for perfusion monitoring of the gastric tube after esophagectomy: a review of technologies and thresholds. Dis Esophagus. 2018;1;31(6). doi: 10.1093/dote/dox161.Ladak F., Dang J.T., Switzer N. at al. Indocyanine green for the prevention of anastomotic leaks following esophagectomy: a meta-analysis. Surg Endo. 2019;33(2):384-394. doi: 10.1007/s00464-018-6503-7.Ladak F., Dang J.T., Switzer N. at al. Indocyanine green for the prevention of anastomotic leaks following esophagectomy: a meta-analysis. Surg Endo. 2019;33(2):384-394. doi: 10.1007/s00464-018-6503-7.Slooter M.D., Eshuis W.J., Cuesta M.A. et al. Fluorescent imaging using indocyanine green during esophagectomy to prevent surgical morbidity: a systematic review and meta-analysis. J Thorac Dis 2019;11(Suppl 5): S755-S765. doi: 10.21037/jtd.2019.01.30.Slooter M.D., Eshuis W.J., Cuesta M.A. et al. Fluorescent imaging using indocyanine green during esophagectomy to prevent surgical morbidity: a systematic review and meta-analysis. J Thorac Dis 2019;11(Suppl 5): S755-S765. doi: 10.21037/jtd.2019.01.30.Arezzo A., Bonino M.A., Ris F. et al.Intraoperative use of fluorescence with indocyanine green reduces anastomotic leak rates in rectal cancer surgery: an individual participant data analysis. Surg Endosc 2020;34(10):4281-4290. doi: 10.1007/s00464-020-07735-w.Arezzo A., Bonino M.A., Ris F. et al.Intraoperative use of fluorescence with indocyanine green reduces anastomotic leak rates in rectal cancer surgery: an individual participant data analysis. Surg Endosc 2020;34(10):4281-4290. doi: 10.1007/s00464-020-07735-w.Miyashita R., Tokutake A., Nimori S., Goto H. Importance of intraoperative indocyanine green imaging in the management of non-occlusive mesenteric ischemia: a case report. Surg Case Rep. 2023;27;9(1):31. doi: 10.1186/s40792-023-01614-x.Miyashita R., Tokutake A., Nimori S., Goto H. Importance of intraoperative indocyanine green imaging in the management of non-occlusive mesenteric ischemia: a case report. Surg Case Rep. 2023;27;9(1):31. doi: 10.1186/s40792-023-01614-x.Watt-Boolsen S. Non-occlusive intestinal infarction. Acta Chir Scand. 1977;143:365-369.Watt-Boolsen S. Non-occlusive intestinal infarction. Acta Chir Scand. 1977;143:365-369.Diana M., Halvax P., Dallemagne B. et al. Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery. Surg Endosc. 2014;28(11):3108-18. doi: 10.1007/s00464-014-3592-9.Diana M., Halvax P., Dallemagne B. et al. Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery. Surg Endosc. 2014;28(11):3108-18. doi: 10.1007/s00464-014-3592-9.Son G.M., Kwon M.S., Kim Y. Quantitative analysis of colon perfusion pattern using indocyanine green (ICG) angiography in laparoscopic colorectal surgery. Surg Endosc. 2019;33(5):1640-1649. doi: 10.1007/s00464-018-6439-y.Son G.M., Kwon M.S., Kim Y. Quantitative analysis of colon perfusion pattern using indocyanine green (ICG) angiography in laparoscopic colorectal surgery. Surg Endosc. 2019;33(5):1640-1649. doi: 10.1007/s00464-018-6439-y.Wada T., Kawada K., Takahashi R. et al. ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery. Surg Endosc. 2017;31(10):4184-4193. doi: 10.1007/s00464-017-5475-3.Wada T., Kawada K., Takahashi R. et al. ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery. Surg Endosc. 2017;31(10):4184-4193. doi: 10.1007/s00464-017-5475-3.Lütken C.D., Achiam M.P., Osterkamp J. at al. Quantification of fluorescence angiography: Toward a reliable intraoperative assessment of tissue perfusion - A narrative review. Langenbecks Arch Surg. 2021;406(2):251-259. doi: 10.1007/s00423-020-01966-0.Lütken C.D., Achiam M.P., Osterkamp J. at al. Quantification of fluorescence angiography: Toward a reliable intraoperative assessment of tissue perfusion - A narrative review. Langenbecks Arch Surg. 2021;406(2):251-259. doi: 10.1007/s00423-020-01966-0.Diana M, Noll E., Diemunsch P. Enhanced-reality video fluorescence: a real-time assessment of intestinal viability. Ann Surg. 2014;259(4):700-7. doi: 10.1097/SLA.0b013e31828d4ab3.Diana M, Noll E., Diemunsch P. Enhanced-reality video fluorescence: a real-time assessment of intestinal viability. Ann Surg. 2014;259(4):700-7. doi: 10.1097/SLA.0b013e31828d4ab3.Matsui A., Winer J.H., Laurence R.G., Frangioni J.V. Predicting the survival of experimental ischaemic small bowel using intraoperative near-infrared fluorescence angiography. Br J Surg. 2011;98(12):1725-34. doi: 10.1002/bjs.7698.Matsui A., Winer J.H., Laurence R.G., Frangioni J.V. Predicting the survival of experimental ischaemic small bowel using intraoperative near-infrared fluorescence angiography. Br J Surg. 2011;98(12):1725-34. doi: 10.1002/bjs.7698.Duprée A., Rieß H., von Kroge P.H. at al.Intraoperative quality assessment of tissue perfusion with indocyanine green (ICG) in a porcine model of mesenteric ischemia. PLoS One. 2021;20;16(7): e0254144. doi: 10.1371/journal.pone.0254144.Duprée A., Rieß H., von Kroge P.H. at al.Intraoperative quality assessment of tissue perfusion with indocyanine green (ICG) in a porcine model of mesenteric ischemia. PLoS One. 2021;20;16(7): e0254144. doi: 10.1371/journal.pone.0254144.Chiu C.J., McArdle A.H., Brown R. at al.Intestinal mucosal lesion in low-flow states. I. A morphological, hemodynamic, and metabolic reappraisal. Arch Surg. 1970;101(4):478-483. doi: 10.1001/archsurg.1970.01340280030009.Chiu C.J., McArdle A.H., Brown R. at al.Intestinal mucosal lesion in low-flow states. I. A morphological, hemodynamic, and metabolic reappraisal. Arch Surg. 1970;101(4):478-483. doi: 10.1001/archsurg.1970.01340280030009.Karliczek A., Harlaar N.J., Zeebregts C.J. at al. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery.Int J Colorectal Dis. 2009;24(5):569-576. doi: 10.1007/s00384-009-0658-6.Karliczek A., Harlaar N.J., Zeebregts C.J. at al. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery.Int J Colorectal Dis. 2009;24(5):569-576. doi: 10.1007/s00384-009-0658-6.

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