Yang Feng, Gao Jian, Cheng Sida, Li Hao, He Kunshan, Zhou Jian, Chen Kezhong, Wang Zhenfan, Yang Fan, Zhang Zeyu, Li Jianfeng, Zhou Zuli, Chi Chongwei, Li Yun, Wang Jun
Department of Thoracic Surgery, Center of Thoracic Mini-invasive Surgery, Peking University People's Hospital, Beijing, China.
CAS Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
Dis Esophagus. 2023 Jan 28;36(2). doi: 10.1093/dote/doac049.
Chylothorax is a serious complication after esophagectomy and there are unmet needs for new intraoperative navigation tools to reduce its incidence. The aim of this study is to explore the feasibility and effectiveness of near-infrared fluorescence imaging (NIR-FI) with indocyanine green (ICG) to identify thoracic ducts (TDs) and chyle leakage during video-assisted thoracoscopic esophagectomy. We recruited 41 patients who underwent thoraco-laparoscopic minimally invasive esophagectomy (MIE) for esophageal cancer in this prospective, open-label, single-arm clinical trial. ICG was injected into the right inguinal region before operations, after which TD anatomy and potential chyle leakage were checked under the near-infrared fluorescence intraoperatively. In 38 of 41 patients (92.7%) using NIR-FI, TDs were visible in high contrast. The mean signal-to-background ratio (SBR) value of all fluorescent TDs was 3.05 ± 1.56. Fluorescence imaging of TDs could be detected 0.5 hours after ICG injection and last up to 3 hours with an acceptable SBR value. The optimal observation time window is from about 1 to 2 hours after ICG injection. Under the guidance of real-time NIR-FI, three patients were found to have chylous leakage and the selective TD ligations were performed intraoperatively. No patient had postoperative chylothorax. NIR-FI with ICG can provide highly sensitive and real-time assessment of TDs as well as determine the source of chyle leakage, which might help reduce TD injury and direct selective TD ligation. It could be a promising navigation tool to reduce the incidence of chylothorax after minimally invasive esophagectomy.
乳糜胸是食管切除术后的一种严重并发症，目前对于降低其发生率的新型术中导航工具仍存在未满足的需求。本研究的目的是探讨吲哚菁绿（ICG）近红外荧光成像（NIR-FI）在电视辅助胸腔镜食管切除术中识别胸导管（TDs）和乳糜漏的可行性和有效性。在这项前瞻性、开放标签、单臂临床试验中，我们招募了41例因食管癌接受胸腹腔镜微创食管切除术（MIE）的患者。术前将ICG注入右腹股沟区，然后在术中近红外荧光下检查TDs的解剖结构和潜在的乳糜漏。在41例使用NIR-FI的患者中，有38例（92.7%）TDs显示出高对比度。所有荧光TDs的平均信号背景比（SBR）值为3.05±1.56。ICG注射后0.5小时可检测到TDs的荧光成像，可持续长达3小时，SBR值可接受。最佳观察时间窗为ICG注射后约1至2小时。在实时NIR-FI的引导下，发现3例患者有乳糜漏，并在术中进行了选择性TD结扎。无患者发生术后乳糜胸。ICG近红外荧光成像可对TDs进行高灵敏度和实时评估，并确定乳糜漏的来源，这可能有助于减少TD损伤并指导选择性TD结扎。它可能是一种有前景的导航工具，可降低微创食管切除术后乳糜胸的发生率。
