Schlottmann Francisco, Patti Marco G
Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
J Laparoendosc Adv Surg Tech A. 2017 Dec;27(12):1305-1308. doi: 10.1089/lap.2017.0359. Epub 2017 Aug 17.
Anastomotic leakage is a determining factor of morbidity and mortality after an esophagectomy. An adequate blood supply of the gastric conduit is vital to prevent this complication. We aimed to determine the feasibility and usefulness of indocyanine green (ICG) fluorescence imaging to evaluate the gastric conduit perfusion during an esophagectomy.
Patients with distal esophageal cancer or esophagogastric junction cancer scheduled for esophagectomy were enrolled in this study. After pulling up the gastric conduit into the chest and before performing the anastomosis, 5 mg of ICG was injected as a bolus. Visual assessment of the blood supply of the gastric conduit was compared with the ICG fluorescence imaging pattern of perfusion.
Five patients were included in this study. Hybrid Ivor Lewis esophagectomy (laparoscopic abdomen and right thoracotomy) was performed in all cases. In all patients, visual assessment of the perfusion of the stomach determined that the conduit was well perfused. In two patients (40%), ICG fluorescence showed an inadequate blood supply of the conduit's tip. Resection of the devitalized portion of the conduit was performed in these two patients. No anastomotic leaks were recorded, and all patients had an uneventful postoperative course.
Visual assessment of the gastric conduit may underestimate perfusion and inadequate blood supply. ICG fluorescence imaging is a promising tool to determine the gastric conduit perfusion during an esophagectomy. Prospective studies with larger series are warranted to confirm the usefulness of ICG fluorescence imaging during an esophagectomy.
吻合口漏是食管切除术后发病率和死亡率的决定因素。胃管道充足的血供对于预防这一并发症至关重要。我们旨在确定吲哚菁绿（ICG）荧光成像在食管切除术中评估胃管道灌注的可行性和实用性。
本研究纳入计划行食管切除术的远端食管癌或食管胃交界癌患者。将胃管道提拉至胸腔后、进行吻合术前，静脉推注5mg ICG。将胃管道血供的视觉评估与ICG荧光成像灌注模式进行比较。
本研究纳入5例患者。所有病例均行改良Ivor Lewis食管切除术（腹腔镜辅助腹部和右胸切口）。所有患者中，通过视觉评估胃的灌注情况确定管道血供良好。2例患者（40%）ICG荧光显示管道尖端血供不足。这2例患者对管道失活部分进行了切除。未记录到吻合口漏，所有患者术后过程顺利。
对胃管道的视觉评估可能会低估灌注及血供不足情况。ICG荧光成像在食管切除术中是一种很有前景的确定胃管道灌注的工具。需要开展更大样本量的前瞻性研究以证实ICG荧光成像在食管切除术中的实用性。
