Dvoretsky S Yu, Kapshuk Ya Yu, Komarov I V, Akopov A L
Pavlov First State Medical University of St. Petersburg, St. Petersburg, Russia.
Khirurgiia (Mosk). 2023(11):72-81. doi: 10.17116/hirurgia202311172.
To evaluate the possibilities of intraoperative indocyanine green fluorescein angiography (ICG technology) in primary esophagoplasty by gastric conduit in patients with malignant tumors of the esophagus.
The study included 74 patients. Depending on the localization of the tumor in the esophagus, a Lewis-type or McKeown-type operation was performed. The retrospective group (surgery without the use of ICG technology) included 53 patients who underwent surgery from 2015 to 2020 years.The prospective group (surgery with the use ICG technology) included 21 patients operated on from 2021 to 2023 years. ICG technology was used to assess microcirculation in the gastric conduit during esophagoplasty, as well as to identify the right gastroepiploic artery.
The ICG fluorescein angiography technique for assessing microcirculation in the gastric conduit was a simple and easily reproducible procedure. Perfusion of the gastric conduit was regarded as satisfactory in 16 (76%) cases, unsatisfactory in 5 (24%) cases, which required resection of the distal part of the conduit. All cases of poor perfusion were in patients with narrow gastric conduit and neck anastomosis location (McKeown-type operation). Anastomotic leakages occurred in 8 (15%) patients in the retrospective group, 4 (19%) patients in the prospective group (>0.05). In 4 out of 5 cases of poor gastric conduit perfusion, anastomotic leaks occurred. Immediate postoperative results in the compared groups were also comparable. The use of ICG technology in 5 (45%) cases out of 11, when laparoscopic mobilization of the stomach was performed, helped to visualize the right gastroepiploic artery, which is the main source of blood supply to the formed gastric conduit. The use of ICG technology in 3 patients with a compromised gastrostomy stomach demonstrated the absence of significant microcirculation disorders in the stomach wall.
The first experience of using fluorescein angiography with ICG in primary esophagoplasty by gastric conduit in patients with malignant tumors of the esophagus demonstrated the safety, simplicity and availability of this technique. An objective assessment of the effectiveness of the application of ICG technology requires the accumulation of experience.
评估术中吲哚菁绿荧光血管造影术（ICG技术）在食管癌患者原发性食管胃成形术中的应用可能性。
该研究纳入74例患者。根据肿瘤在食管中的位置，进行Lewis型或McKeown型手术。回顾性组（未使用ICG技术的手术）包括2015年至2020年接受手术的53例患者。前瞻性组（使用ICG技术的手术）包括2021年至2023年接受手术的21例患者。ICG技术用于评估食管胃成形术中胃管的微循环，以及识别胃网膜右动脉。
用于评估胃管微循环的ICG荧光血管造影技术是一种简单且易于重复的操作。胃管灌注在16例（76%）中被认为满意，5例（24%）不满意，这需要切除胃管的远端部分。所有灌注不良的病例均为胃管狭窄且颈部吻合部位（McKeown型手术）的患者。回顾性组有8例（15%）患者发生吻合口漏，前瞻性组有4例（19%）患者发生吻合口漏（>0.05）。5例胃管灌注不良的病例中有4例发生吻合口漏。两组术后即刻结果也具有可比性。在11例进行腹腔镜胃游离的病例中，有5例（45%）使用ICG技术有助于可视化胃网膜右动脉，它是形成的胃管的主要血液供应来源。在3例胃造口胃功能受损的患者中使用ICG技术显示胃壁无明显微循环障碍。
在食管癌患者原发性食管胃成形术中首次使用ICG进行荧光血管造影的经验证明了该技术的安全性、简单性和实用性。对ICG技术应用效果的客观评估需要积累经验。
