Kumagai Y, Hatano S, Sobajima J, Ishiguro T, Fukuchi M, Ishibashi K-I, Mochiki E, Nakajima Ya, Ishida H
Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama.
Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Dis Esophagus. 2018 Dec 1;31(12). doi: 10.1093/dote/doy052.
By examining the reconstructed gastric tube during esophagectomy using indocyanine green fluorescence (ICG) angiography, we have established a '90-second rule' to confirm good blood perfusion at the anastomosis site. We examined the surgical outcome (rate of anastomotic leakage) of 70 consecutive patients who underwent esophagectomy with gastric tube reconstruction using ICG fluorescence angiography. All of the anastomoses were made in the area where less than 90 seconds was needed for enhancement using ICG fluorescence angiography (i.e. within the 90-second rule). In 18 cases for which the time until enhancement of the gastric tube tip exceeded 60 seconds, the anastomosis site was decided by reference to the ICG fluorescence angiogram, and the hypoperfused area was excised, and this significantly shortened the median time until enhancement of the gastric tube tip from 95.5 (60.0-204.0) seconds to 41.0 (9.0-77.0) seconds (P < 0.001). In three cases, the anastomosis was made at the site where more than 60 seconds was needed for ICG enhancement. In one case where ICG enhancement had taken 77 seconds, minor anastomotic leakage occurred. The overall rate of anastomotic leakage in this series was 1.4%. Blood flow in the reconstructed gastric tube is sufficient if the anastomosis is made in the area where ICG fluorescence angiography demonstrates enhancement within 60 seconds. Gastric tube necrosis can be avoided if the area showing an enhancement time exceeding 90 seconds is excised. The 90-second rule is a safe and effective method for deciding the site of anastomosis.
通过使用吲哚菁绿荧光（ICG）血管造影术在食管切除术期间检查重建的胃管，我们建立了一个“90秒规则”，以确认吻合部位的良好血液灌注。我们使用ICG荧光血管造影术检查了70例连续接受食管切除术并进行胃管重建的患者的手术结果（吻合口漏发生率）。所有吻合均在使用ICG荧光血管造影术增强所需时间少于90秒的区域进行（即符合90秒规则）。在18例胃管尖端增强时间超过60秒的病例中，根据ICG荧光血管造影图确定吻合部位，切除灌注不足的区域，这显著缩短了胃管尖端增强的中位时间，从95.5（60.0 - 204.0）秒缩短至41.0（9.0 - 77.0）秒（P < 0.001）。在3例病例中，吻合在ICG增强需要超过60秒的部位进行。在1例ICG增强耗时77秒的病例中，发生了轻微的吻合口漏。本系列中吻合口漏的总体发生率为1.4%。如果在ICG荧光血管造影显示60秒内增强的区域进行吻合，重建胃管的血流是充足的。如果切除增强时间超过90秒的区域，可以避免胃管坏死。90秒规则是确定吻合部位的一种安全有效的方法。
