Ishii Kenjiro, Tsubosa Yasuhiro, Nakao Junichi, Haneda Ryoma, Ishii Yoshitaka, Booka Eisuke, Mayanagi Shuhei, Araki Jun, Yasunaga Yoshichika, Nakagawa Masahiro
Division of Esophageal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan.
Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan.
Ann Med Surg (Lond). 2020 Dec 5;62:21-25. doi: 10.1016/j.amsu.2020.12.008. eCollection 2021 Feb.
Pedicled jejunal flap can be utilized with various tips for esophageal reconstruction in patients with a history of gastrectomy or those who have undergone synchronous esophagogastrectomy. However, the rate of anastomosis leakage is high; therefore, we considered the evaluation of blood flow of the remnant esophagus with indocyanine green in setting the anastomosis site.
Fifty patients who underwent radical esophagectomy with pedicled jejunal flap between January 2011 and June 2020 were identified. From June 2019, blood flow in the pedicled jejunum and remnant esophagus were evaluated to set the anastomosis site of the latter. Usually, the second and third jejunal vessels are transected, and if the jejunal flap cannot reach to the anastomosis point, we actively transect the marginal vessels to stretch the jejunal flap. Microvascular anastomosis between the jejunal branches and the internal thoracic vessels is usually made, and the anastomosis site is set at the well-stained part of the esophagus.
Overall, 39 patients underwent the procedure before June 2019 (Group A), and 11 patients underwent the procedure since June 2019 (Group B). No significant difference was found in the patients' background, type of preoperative therapy, presence or absence of ligation of marginal vessels and two-stage operation between the groups. Group A had 16 cases of anastomosis leakage; B had only 1 case ( < 0.05). There were no cases of pedicled jejunum graft necrosis.
Assessing remnant esophageal perfusion by indocyanine green imaging in pedicled jejunum reconstruction resulted in a lower anastomotic leak rate.
带蒂空肠瓣可用于胃切除术后或同期食管胃切除术后患者的食管重建，可采用多种瓣尖。然而，吻合口漏发生率较高；因此，我们考虑在确定吻合部位时，使用吲哚菁绿评估残余食管的血流情况。
选取2011年1月至2020年6月期间接受带蒂空肠瓣根治性食管切除术的50例患者。从2019年6月起，在确定残余食管吻合部位时，对带蒂空肠和残余食管的血流进行评估。通常切断空肠第二和第三支血管，如果空肠瓣无法到达吻合点，则积极切断边缘血管以拉伸空肠瓣。通常在空肠分支与胸廓内血管之间进行微血管吻合，并将吻合部位设定在食管染色良好的部位。
总体而言，39例患者在2019年6月前接受手术（A组），11例患者自2019年6月起接受手术（B组）。两组患者的背景、术前治疗类型、边缘血管结扎情况及两阶段手术情况均无显著差异。A组有16例吻合口漏；B组仅有1例（P<0.05）。无带蒂空肠移植坏死病例。
在带蒂空肠重建术中，通过吲哚菁绿成像评估残余食管灌注可降低吻合口漏发生率。
