Ishiguro Toru, Kumagai Youichi, Ono Tomojiro, Imaizumi Hideko, Honjo Hiroaki, Suzuki Okihide, Ito Tetsuya, Haga Norihiro, Kuwabara Kohki, Sobajima Jun, Kumamoto Kensuke, Ishibashi Keiichoro, Baba Hiroyuki, Ishida Hideyuki, Kawano Tatsuyuki
1 Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Int Surg. 2012 Oct-Dec;97(4):340-4. doi: 10.9738/CC159.1.
We report a case of necrosis of a reconstructed gastric tube in a 77-year-old male patient who had undergone esophagectomy. At the time of admission, the patient had active gastric ulcers, but these were resolved by treatment with a proton pump inhibitor. Subtotal esophagectomy with gastric tube reconstruction was performed. Visually, the reconstructed gastric tube appeared to be well perfused with blood. Using indocyanine green (ICG) fluorescence imaging the gastroepiploic vessels were well enhanced and no enhancement was visable 3 to 4 cm from the tip of the gastric tube. Four days after esophagectomy, gastric tube necrosis was confirmed, necessitating a second operation. The necrosis of the gastric tube matched the area that had been shown to lack blood perfusion by ICG angiography imaging. It seems that ICG angiography is useful for the evaluation of perfusion in a reconstructed gastric tube.
我们报告一例77岁男性患者，其在接受食管切除术后重建胃管发生坏死。入院时，患者有活动性胃溃疡，但经质子泵抑制剂治疗后溃疡得到缓解。实施了胃管重建的次全食管切除术。肉眼可见，重建的胃管血运良好。使用吲哚菁绿（ICG）荧光成像，胃网膜血管增强良好，而在距胃管尖端3至4厘米处未见增强。食管切除术后四天，证实胃管坏死，需要进行二次手术。胃管坏死区域与ICG血管造影成像显示缺乏血流灌注的区域相符。看来ICG血管造影术对于评估重建胃管的灌注情况是有用的。
