Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
Department of Digestive Tract and General Surgery, Saitama Medical Center, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan.
Gen Thorac Cardiovasc Surg. 2021 Jul;69(7):1118-1124. doi: 10.1007/s11748-021-01640-2. Epub 2021 Apr 30.
We determined the anastomotic site during gastric tube reconstruction in esophagectomy according to the "90-to 60-s rule" using indocyanine green (ICG) fluorescence angiography. We evaluated its safety and efficacy in a prospective multicenter setting.
We enrolled 129 patients who underwent subtotal esophagectomy for esophageal cancer. ICG fluorescence angiography was performed after making a wide gastric tube, and the time from the initial enhancement of the right gastroepiploic artery to the tip of the gastric tube was used as a parameter. Esophago-gastro anastomosis was made at the area that was enhanced within 90 s (preferably within 60 s). The enhancement time and the incidence of anastomotic leakage were compared.
In all cases, anastomosis was made at the site enhanced within 90 s. Anastomotic leakage was found in only 4 (3.1%) of 129 cases; specifically, it was detected in 3 (2.4%) of 126 cases whose anastomotic site was enhanced within 60 s and in 1 (33.3%) of 3 cases where the enhancement time exceeded 60 s (p = 0.09).
Determining the anastomotic site using the 90-to 60-s rule with ICG imaging in gastric tube reconstruction helps reduce the rate of anastomotic leakage.
我们通过使用吲哚菁绿（ICG）荧光血管造影，根据“90-60 秒规则”确定食管切除术胃管重建中的吻合部位。我们在一项前瞻性多中心研究中评估了其安全性和有效性。
我们招募了 129 名接受食管癌次全食管切除术的患者。在制作宽胃管后进行 ICG 荧光血管造影，将胃网膜右动脉初始增强到胃管尖端的时间作为参数。吻合口位于 90 秒内（最好 60 秒内）增强的区域。比较增强时间和吻合口漏的发生率。
在所有病例中，吻合口均位于 90 秒内增强的部位。仅在 129 例中发现 4 例（3.1%）吻合口漏，其中 126 例（2.4%）吻合口在 60 秒内增强，3 例（33.3%）超过 60 秒增强（p=0.09）。
在胃管重建中使用 ICG 成像的 90-60 秒规则确定吻合部位有助于降低吻合口漏的发生率。
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