Nishino Hitoe, Takano Shigetsugu, Yoshitomi Hideyuki, Furukawa Katsunori, Takayashiki Tsukasa, Kuboki Satoshi, Suzuki Daisuke, Sakai Nozomu, Kagawa Shingo, Nojima Hiroyuki, Sasaki Kosuke, Miyazaki Masaru, Ohtsuka Masayuki
Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan.
Surg Open Sci. 2019 May 24;1(1):14-19. doi: 10.1016/j.sopen.2019.04.004. eCollection 2019 Jul.
Ischemic gastropathy (IG) is a major complication after distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for locally advanced body/tail pancreatic ductal adenocarcinoma (PDAC), and its incidence is still unknown.
To evaluate the occurrence of IG, 77 and 18 consecutive patients with body/tail PDAC were analyzed in a retrospective and a prospective study, respectively. We utilized perioperative gastroendoscopy, Gastrointestinal Quality of Life Index (GIQLI) score, and quantitative assessment for gastric arterial blood flow using the HyperEye Medical System (HEMS) with indocyanine green (ICG) fluorescence imaging in the prospective arm.
In the retrospective arm, no significant difference was noted in the occurrence rate of IG between the DP-CAR (8.7%) and DP groups (5.5%). In the prospective arm, the postoperative endoscopic scores were significantly higher in the DP-CAR group (45%) than in the DP group (11%) ( < .0007) despite no difference in the GIQLI score. The ICG-HEMS imaging system demonstrated more delayed arterial flow velocity in the IG (+) group ( < .028), but showed no significant difference in arterial flow volume compared to the IG (-) group.
This is the first demonstration assessing IG incidence after DP-CAR using multiple methods. Despite the high IG rate, gastric arterial flow volume was almost equally maintained in DP-CAR patients with or without IG compared with the DP group. We should note the fact that many of the IG patients do not present with typical symptoms, and proper treatment is required for those "silent" IG patients.
缺血性胃病（IG）是局部进展期体/尾胰腺导管腺癌（PDAC）行胰体尾切除术联合区域淋巴结清扫术（DP-CAR）后的主要并发症，其发生率尚不清楚。
为评估IG的发生率，分别对77例和18例连续的体/尾PDAC患者进行回顾性和前瞻性研究。在前瞻性研究中，我们采用围手术期胃镜检查、胃肠道生活质量指数（GIQLI）评分，以及使用带有吲哚菁绿（ICG）荧光成像的HyperEye Medical System（HEMS）对胃动脉血流进行定量评估。
在回顾性研究中，DP-CAR组（8.7%）和DP组（5.5%）的IG发生率无显著差异。在前瞻性研究中，尽管GIQLI评分无差异，但DP-CAR组术后内镜评分（45%）显著高于DP组（11%）（P<0.0007）。ICG-HEMS成像系统显示IG（+）组动脉血流速度延迟更明显（P<0.028），但与IG（-）组相比，动脉血流量无显著差异。
这是首次使用多种方法评估DP-CAR术后IG发生率的研究。尽管IG发生率较高，但与DP组相比，有或无IG的DP-CAR患者胃动脉血流量几乎同样得以维持。我们应注意到许多IG患者没有典型症状这一事实，对于这些“无症状”的IG患者需要进行适当治疗。
