Khitaryan A G, Melnikov D A, Mezhunts A V, Rogut A A, Pen O S, Pukovskiy D Yu
Private healthcare institution «Clinical Hospital» Russian Railways-Medicine «Rostov-on-Don», Rostov-on-Don, Russia.
Rostov State Medical University, Rostov-on-Don, Russia.
Khirurgiia (Mosk). 2024(7):115-123. doi: 10.17116/hirurgia2024071115.
To examine the specific characteristics of ICG-angiography during various bariatric interventions.
The study included 329 patients, with 105 (32%) undergoing sleeve gastrectomy (LSG), 98 (30%) undergoing mini-gastricbypass (MGB), 126 (38%) undergoing Roux-en-Y gastric bypass (RGB). Intraoperative ICG angiography was perfomed on all patients at 'control points', the perfusion of the gastric stump was qualitatively and quantitatively assessed.
Intraoperative ICG angiography shows that during LSG the angioarchitectonics in the area of the His angle are crucial. The presence of the posterior gastric artery of the gastric main type is a prognostically unfavorable risk factor for the development of ischemic complications. Therefore, to expand the gastric stump it is necessary to suture a 40Fr nasogastric tube and perform peritonization of the staple line. Statistical difference in blood supply at three points were found between and within the two groups of patients (Gis angle area, gastric body, pyloric region) with a -value <0.001. During MGB, one of the important stages is applying the first (transverse) stapler cassette between the branches of the right and left gastric arteries. This maintains blood supply in anastomosis area, preventing immediate complications such as GEA failure, as well as long-term complications like atrophic gastritis, peptic ulcers, and GEA stenosis.
ICG angiography is a useful method for intraoperative assessment of angioarchitecture and perfusion of the gastric stump during bariatric surgery. This helps prevent tissue ischemia and reduce the risk of early and late postoperative complications.
研究不同减重手术中吲哚菁绿血管造影的具体特征。
该研究纳入329例患者，其中105例（32%）接受袖状胃切除术（LSG），98例（30%）接受迷你胃旁路术（MGB），126例（38%）接受Roux-en-Y胃旁路术（RGB）。所有患者在“控制点”进行术中吲哚菁绿血管造影，对胃残端的灌注进行定性和定量评估。
术中吲哚菁绿血管造影显示，在LSG过程中，His角区域的血管构筑至关重要。胃主型胃后动脉的存在是发生缺血性并发症的预后不良危险因素。因此，为扩大胃残端，有必要缝合一根40Fr的鼻胃管并对吻合钉线进行腹膜化处理。两组患者（His角区域、胃体、幽门区域）在三个点的血供存在组间和组内统计学差异，P值<0.001。在MGB过程中，重要步骤之一是在左右胃动脉分支之间应用第一个（横向）吻合器钉仓。这可维持吻合口区域的血供，预防诸如GEA失败等即刻并发症以及萎缩性胃炎、消化性溃疡和GEA狭窄等长期并发症。
吲哚菁绿血管造影是减重手术中评估胃残端血管构筑和灌注的有用方法。这有助于预防组织缺血并降低术后早期和晚期并发症的风险。
