Campbell Chase, Reames Mark K, Robinson Myra, Symanowski James, Salo Jonathan C
Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
J Gastrointest Surg. 2015 May;19(5):806-12. doi: 10.1007/s11605-015-2794-3. Epub 2015 Mar 20.
Anastomotic leak following esophagectomy is associated with significant morbidity and mortality. A major factor determining anastomotic success is an adequate blood supply to the conduit. The aim of this study was to determine the impact of intraoperative evaluation of the conduit's vascular supply on anastomotic failure after esophagectomy.
We retrospectively analyzed data from 90 consecutive patients undergoing esophagectomy with gastric conduit reconstruction. A change in surgical practice occurred after 60 cases were completed, when we introduced the use of intraoperative indocyanine green fluorescence angiography and Doppler examination to evaluate blood supply and assist in construction of the conduit. The leak rates before and after implementation of conduit vascular evaluation were compared.
After the introduction of intraoperative vascular evaluation of the gastric conduit, we noted a dramatic decrease in the rate of anastomotic leak from 20 % in the first 60 patients to 0 % in the succeeding 30 patients.
Intraoperative vascular evaluation with indocyanine green fluorescence imaging and Doppler examination of the gastric conduit used to assist reconstruction after esophagectomy allows for enhanced construction of the conduit that maximizes blood supply to the anastomosis. This change in practice was associated with a significant reduction in anastomotic leak rate.
食管切除术后吻合口漏与显著的发病率和死亡率相关。决定吻合成功的一个主要因素是管道有充足的血液供应。本研究的目的是确定术中评估管道血管供应对食管切除术后吻合失败的影响。
我们回顾性分析了90例连续接受食管切除并采用胃管道重建患者的数据。在完成60例手术之后，手术方式发生了改变，当时我们引入了术中吲哚菁绿荧光血管造影和多普勒检查来评估血液供应并辅助管道构建。比较了实施管道血管评估前后的漏率。
引入胃管道术中血管评估后，我们注意到吻合口漏率从最初60例患者中的20%急剧下降至随后30例患者中的0%。
术中采用吲哚菁绿荧光成像和多普勒检查对用于食管切除术后辅助重建的胃管道进行血管评估，能够加强管道构建，使吻合口的血液供应最大化。这种手术方式的改变与吻合口漏率的显著降低相关。
