Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan,
World J Surg. 2014 Jan;38(1):138-43. doi: 10.1007/s00268-013-2237-9.
Construction of a gastric tube that is well perfused with blood during esophagectomy is the most important factor in avoiding anastomotic leakage. We clarified the hemodynamics of the reconstructed gastric tube with indocyanine green (ICG) fluorescence.
In 20 patients undergoing gastric tube reconstruction during esophagectomy, we evaluated blood flow in the gastric tube with ICG fluorescence imaging. We divided the patients into two groups according to the quality of blood flow to the gastric tube-"good" (n = 9) and "sparse or absent" (n = 11)-based on visual assessment of the anastomosis of the right and left gastroepiploic vessels. We measured the time from initial enhancement of the root of the right gastroepiploic artery until enhancement of the most cranial branch of the left gastroepiploic artery and tip of the gastric tube.
The gastric tube was divisible into three zones according to the dominant arteries present in the greater curvature under ICG fluorescence. The left gastroepiploic artery was enhanced in a direction opposite that of physiological blood flow in all cases. The median period from initial enhancement of the root of the right gastroepiploic artery to the most cranial branch of the left gastroepiploic artery until perfusion up to the tip of the gastric tube did not differ significantly between the "good" and the "sparse or absent" groups (P = 0.24, 0.68) CONCLUSIONS: It is essential to preserve the whole vessel arcade of the greater curvature to achieve good blood perfusion in the gastric tube. The ICG fluorescence method has potential usefulness for evaluation of blood flow in the gastric tube.
在食管癌切除术过程中，构建血供良好的胃管是避免吻合口漏的最重要因素。我们使用吲哚菁绿（ICG）荧光来阐明重建胃管的血液动力学。
在 20 例接受胃管重建的食管癌患者中，我们使用 ICG 荧光成像评估胃管的血流情况。我们根据胃网膜右、左血管吻合口的视觉评估将患者分为两组——“良好”（n=9）和“稀疏或缺失”（n=11）。我们测量了从胃网膜右动脉根部初始增强到胃网膜左动脉最颅侧分支和胃管尖端增强的时间。
根据 ICG 荧光下胃大弯的优势动脉，胃管可分为三个区域。在所有情况下，胃网膜左动脉均沿与生理血流相反的方向增强。从胃网膜右动脉根部初始增强到胃网膜左动脉最颅侧分支直到胃管尖端灌注的中位时间在“良好”和“稀疏或缺失”组之间无显著差异（P=0.24，0.68）。
保留胃大弯的整个血管弓对于实现胃管的良好血供至关重要。ICG 荧光法对评估胃管的血流具有潜在的有用性。
