Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Dis Esophagus. 2022 May 10;35(5). doi: 10.1093/dote/doab079.
Impaired gastric conduit perfusion is a risk factor for anastomotic leak after esophagectomy. The aim of this study is to evaluate the feasibility of intraoperative quantitative assessment of gastric conduit perfusion with indocyanine green fluorescence angiography as a predictor for cervical esophagogastric anastomotic leak after esophagectomy. Indocyanine green fluorescence angiography using the SPY Elite system was performed in patients undergoing a transhiatal or McKeown esophagectomy from July 2015 through December 2020. Ingress (dye uptake) and Egress (dye exit) at two anatomic landmarks (the tip of a conduit and 5 cm from the tip) were assessed. The collected data in the leak group and no leak group were compared by univariate and multivariable analyses. Of 304 patients who were evaluated, 70 patients developed anastomotic leak (23.0%). There was no significant difference in patients' demographic between the groups. Ingress Index, which represents a proportion of blood inflow, at both the tip and 5 cm of the conduit was significantly lower in the leak group (17.9 vs. 25.4% [P = 0.011] and 35.9 vs. 44.6% [P = 0.019], respectively). Ingress Time, which represents an estimated time of blood inflow, at 5 cm of the conduit was significantly higher in the leak group (69.9 vs. 57.1 seconds, P = 0.006). Multivariable analysis suggested that these three variables can be used to predict future leak. Variables of gastric conduit perfusion correlated with the incidence of cervical esophagogastric anastomotic leak. Intraoperative measurement of gastric conduit perfusion can be predictive for anastomotic leak following esophagectomy.
胃管灌注受损是食管切除术后吻合口漏的危险因素。本研究旨在评估术中使用吲哚菁绿荧光血管造影术对胃管灌注进行定量评估的可行性，作为预测食管切除术后颈段食管胃吻合口漏的指标。2015 年 7 月至 2020 年 12 月，对接受经食管裂孔或 McKeown 食管切除术的患者进行吲哚菁绿荧光血管造影术。评估两个解剖学标志（管尖和距尖端 5cm）的入（染料摄取）和出（染料排出）。通过单变量和多变量分析比较漏诊组和无漏诊组的收集数据。在 304 例接受评估的患者中，70 例发生吻合口漏（23.0%）。两组患者的人口统计学特征无显著差异。在漏诊组，导丝尖端和距尖端 5cm 处的流入指数（代表血流流入比例）明显较低（17.9%比 25.4%[P=0.011]和 35.9%比 44.6%[P=0.019]）。在漏诊组，距导管尖端 5cm 处的流入时间（代表估计的血流流入时间）明显较长（69.9 比 57.1 秒，P=0.006）。多变量分析表明，这三个变量可用于预测未来漏诊。胃管灌注的变量与颈段食管胃吻合口漏的发生率相关。术中测量胃管灌注可以预测食管切除术后吻合口漏。
