Kitadani Junya, Hayata Keiji, Goda Taro, Tominaga Shinta, Fukuda Naoki, Nakai Tomoki, Nagano Shotaro, Ojima Toshiyasu, Kawai Manabu
Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
Surg Laparosc Endosc Percutan Tech. 2024 Dec 1;34(6):619-624. doi: 10.1097/SLE.0000000000001331.
Anastomotic leakage (AL) is a major complication after esophagectomy and gastric tube reconstruction. This retrospective study aims to reveal the factors in prevention of AL and in reduction of its severity.
Enrolled in this study were the 183 patients diagnosed with esophageal cancer who underwent minimally invasive esophagectomy followed by narrow gastric tube reconstruction at Wakayama Medical University Hospital between January 2018 and March 2023. Evaluation of blood perfusion using indocyanine green began in September 2020.
AL occurred in 42 patients (22%) and did not occur in 141 patients (78%). Patient characteristics were not significantly different between patients with and without AL. Evaluation of blood perfusion of the gastric tube was performed in 69 of the 183 patients (37.7%), and after its introduction the rates of AL decreased from 28.0% to 14.4%. Blood perfusion was less evaluated in the AL group than in the non-AL group (23.8% vs. 41.8%, P=0.034). Multivariate analysis demonstrated that non-evaluation of blood perfusion using indocyanine green (odds=3.115) was an independent risk factor for AL. For the patients with AL, active interventions (eg, tube insertion into the gastric tube through the nose or fistula, embolization of cyanoacrylate) were performed significantly more often in the group without evaluation of blood perfusion than in the group with evaluation. Without evaluation of blood perfusion, there was significantly longer time from onset to resumption of diet and significantly longer postoperative hospital stays.
Evaluation of qualitative blood perfusion can lead to both risk reduction and prevention of severe AL after narrow gastric tube reconstruction for esophageal cancer.
吻合口漏（AL）是食管癌切除及胃管重建术后的主要并发症。本回顾性研究旨在揭示预防AL及减轻其严重程度的相关因素。
本研究纳入了2018年1月至2023年3月间在和歌山县立医科大学医院接受微创食管癌切除并窄胃管重建的183例食管癌患者。2020年9月开始使用吲哚菁绿评估血运灌注。
42例患者（22%）发生AL，141例患者（78%）未发生AL。发生AL和未发生AL的患者的患者特征无显著差异。183例患者中的69例（37.7%）进行了胃管血运灌注评估，引入该评估后，AL发生率从28.0%降至14.4%。AL组的血运灌注评估少于非AL组（23.8%对41.8%，P=0.034）。多因素分析表明，未使用吲哚菁绿评估血运灌注（比值=3.115）是AL的独立危险因素。对于发生AL的患者，未进行血运灌注评估的组比进行评估的组更频繁地进行积极干预（如经鼻或经瘘管插入胃管、氰基丙烯酸酯栓塞）。未进行血运灌注评估时，从发病到恢复饮食的时间显著延长，术后住院时间也显著延长。
定性血运灌注评估可降低食管癌窄胃管重建术后严重AL的风险并预防其发生。
