Peristeri Dimitra V, Baltatzis Minas
Department of Upper GI Surgery, Salford Royal Foundation Trust, Northern Care Alliance, Salford, UK.
J Chest Surg. 2025 Jan 5;58(1):5-14. doi: 10.5090/jcs.24.091. Epub 2024 Dec 23.
Postoperative chylothorax is a serious complication after oesophagectomy. Real-time identification of the thoracic duct (TD) could prevent injury or facilitate prompt management when it occurs. Intraoperative TD lymphography with indocyanine green (ICG) is a novel technique that may help prevent chyle leaks following thoracic surgery. A systematic search of PubMed, Embase, MEDLINE, Scopus, and the Cochrane Library for studies published until July 2024 evaluating ICG for TD identification during oesophagectomy was performed. Studies were included in the review if they assessed intraoperative TD identification with ICG to prevent chyle leakage in patients undergoing oesophagectomy. Nine of 265 screened papers were included in the present review, with 3 reporting comparative techniques of TD identification between patients. Only 1 study had a control group without ICG administration. TD was identified in 281 of the 303 patients who received ICG. Chyle leak incidence was 0.66% in the ICG group. The mean observation time of TD after ICG administration was 162 minutes. Most of the included patients received neoadjuvant treatment before surgery. Different application routes of ICG have been reported, with the most prominent one being through the inguinal region under ultrasound guidance. Real- time TD identification with ICG might be a valuable tool for avoiding injury or managing it intraoperatively. To our knowledge, this is the first systematic review on this complex topic. However, as no randomized controlled trials have been published, sufficient evidence is needed to determine whether the aforementioned method can sufficiently reduce the chyle leak rate.
术后乳糜胸是食管切除术后的一种严重并发症。实时识别胸导管（TD）可预防其损伤，或在损伤发生时便于及时处理。术中使用吲哚菁绿（ICG）进行TD淋巴造影是一种新技术，可能有助于预防胸外科手术后的乳糜漏。我们系统检索了截至2024年7月发表在PubMed、Embase、MEDLINE、Scopus和Cochrane图书馆上的研究，以评估ICG在食管切除术中用于识别TD的情况。如果研究评估了术中使用ICG识别TD以预防食管切除术患者乳糜漏的情况，则纳入本综述。在筛选的265篇论文中，有9篇纳入了本综述，其中3篇报告了患者之间TD识别的比较技术。只有1项研究有未给予ICG的对照组。在接受ICG的303例患者中，有281例识别出了TD。ICG组的乳糜漏发生率为0.66%。给予ICG后TD的平均观察时间为162分钟。大多数纳入的患者在手术前接受了新辅助治疗。已有报道ICG的不同应用途径，最突出的一种是在超声引导下通过腹股沟区域应用。使用ICG实时识别TD可能是避免损伤或在术中处理损伤的一种有价值的工具。据我们所知，这是关于这个复杂主题的第一篇系统综述。然而，由于尚未发表随机对照试验，需要足够的证据来确定上述方法是否能充分降低乳糜漏率。
