引用文本：康岳, 秦长江, 戴伟钢. 美国胃肠内镜外科医师协会《2025吲哚菁绿荧光成像引导胃肠手术指南》要点解读[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(3): 369-381.

作者：康岳1，秦长江2，戴伟钢1

单位：1. 中山大学附属第一医院 胃肠外科中心，广东 广州 510080；2. 河南大学淮河医院 普通外科，河南 开封 475000

Authors：Kang Yue1, Qin Changjiang2, Dai Weigang1

Unit：1. Gastrointestinal Surgery Center, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong, China；2. Department of General Surgery, Huaihe Hospital, Henan University, Kaifeng 475000, Henan, China

摘要：

美国胃肠内镜外科医师协会于2025年发布了关于吲哚菁绿荧光成像引导手术在胃肠外科应用的临床指南。本文旨在对该指南进行深度解读。指南采用推荐分级的评价、制定与评估（grading of recommendations assessment, development and evaluation, GRADE）体系，并创新性引入“效用值”加权的临床效应判定阈值来评估证据。针对8个关键临床问题，指南提出了分级推荐建议：强推荐在胃肠癌淋巴结清扫及左半结直肠吻合术中使用吲哚菁绿荧光成像引导手术，以增加淋巴结获取数及改善吻合质量；有条件推荐用于术中识别远处转移灶、原发癌病灶及辅助食管吻合；对于胸导管识别、减重手术及儿科拖出式手术，因缺乏比较性的证据，将其列为可合理选择的专家意见。此外，本文汇总了不同术式的吲哚菁绿给药剂量与时机，对比了该指南与国内共识在注射方式上的异同，并分析了当前证据的局限性与未来研究方向，为临床规范化应用提供参考。

关键词：吲哚菁绿；荧光成像引导手术；胃肠外科；指南

Abstract：

In 2025, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) released the SAGES 2025 guidelines for fluorescence image-guided gastrointestinal surgery using indocyanine green (ICG). This article aims to provide an in-depth interpretation of the guidelines. The guidelines adopt the grading of recommendations assessment, development and evaluation (GRADE) methodology and innovatively introduce "utility value"-weighted clinical effect judgment thresholds to assess the evidence. Addressing eight key questions, the guidelines provide graded recommendations: strong recommendations are made for the use of ICG fluorescence image-guided surgery in lymph node harvesting for gastrointestinal cancers and in left-sided colorectal anastomosis to increase lymph node retrieval and improve anastomotic quality; conditional recommendations are offered for the intraoperative identification of distant metastases and primary cancer lesions, as well as for assisting with esophageal anastomosis; while the use of ICG for thoracic duct identification, bariatric surgery, and pediatric pull-through procedures is supported by expert opinion due to a lack of comparative evidence. Furthermore, this article summarizes the ICG dosing and timing for different surgical procedures, compares the injection methods between the guidelines and the domestic consensus, and analyzes the limitations of current evidence along with directions for future research, providing a reference for standardized clinical application.

Key words：Indocyanine green; Fluorescence image-guided surgery; Gastrointestinal surgery; Guidelines

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