Kim Mina, Son Sang-Yong, Cui Long-Hai, Shin Ho-Jung, Hur Hoon, Han Sang-Uk
Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
J Gastric Cancer. 2017 Jun;17(2):145-153. doi: 10.5230/jgc.2017.17.e17. Epub 2017 Jun 9.
Identification of the infrapyloric artery (IPA) type is a key component of pylorus-preserving gastrectomy. As the indocyanine green (ICG) fluorescence technique is known to help visualize blood vessels and flow during reconstruction, we speculated that this emerging technique would be helpful in identifying the IPA type.
From August 2015 to February 2016, 20 patients who underwent robotic or laparoscopic gastrectomy were prospectively enrolled. After intravenous injection of approximately 3 mL of ICG (2.5 mg/mL), a near-infrared fluorescence apparatus was applied. The identified shape of the IPA was confirmed by examining the actual anatomy following infrapyloric dissection.
The mean interval time between ICG injection and visualization of the artery was 22.2 seconds (range, 14-30 seconds), and the mean duration of the arterial phase was 16.1 seconds (range, 9-30 seconds). The overall positive predictive value (PPV) of ICG fluorescence in identifying the IPA type was 80% (16/20). The IPA type was incorrectly predicted in four patients, all of whom were obese with a body mass index (BMI) of more than 25 kg/m.
Our preliminary results indicate that intraoperative vascular imaging using the ICG fluorescence technique may be helpful for robotic or laparoscopic pylorus-preserving gastrectomy.
识别幽门下动脉（IPA）类型是保留幽门胃切除术的关键组成部分。由于已知吲哚菁绿（ICG）荧光技术有助于在重建过程中可视化血管和血流，我们推测这种新兴技术将有助于识别IPA类型。
2015年8月至2016年2月，前瞻性纳入20例行机器人或腹腔镜胃切除术的患者。静脉注射约3 mL ICG（2.5 mg/mL）后，应用近红外荧光设备。通过检查幽门下解剖后的实际解剖结构来确认IPA的识别形状。
ICG注射与动脉可视化之间的平均间隔时间为22.2秒（范围14 - 30秒），动脉期的平均持续时间为16.1秒（范围9 - 30秒）。ICG荧光识别IPA类型的总体阳性预测值（PPV）为80%（16/20）。4例患者的IPA类型预测错误，所有这些患者均为肥胖患者，体重指数（BMI）超过25 kg/m²。
我们的初步结果表明，使用ICG荧光技术进行术中血管成像可能有助于机器人或腹腔镜保留幽门胃切除术。
