Conduit Vascular Evaluation is Associated with Reduction in Anastomotic Leak After Esophagectomy
Conduit Vascular Evaluation is Associated with Reduction in Anastomotic Leak After Esophagectomy
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DOI：
10.1007/s11605-015-2794-3
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发表时间：
2015-05-01
影响因子：
3.2
通讯作者：
Salo, Jonathan C.
中科院分区：
文献类型：
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作者：
Campbell, Chase;Reames, Mark K.;Salo, Jonathan C.
食管切除术后吻合口漏与显著的发病率和死亡率相关。决定吻合成功的一个主要因素是管道的充足血液供应。本研究的目的是确定术中评估管道的血管供应对食管切除术后吻合失败的影响，我们回顾性分析了90例接受食管切除术与胃管道重建的患者的数据。在完成60例手术后，手术实践发生了变化，当时我们引入了术中吲哚菁绿色荧光血管造影和多普勒检查的使用，以评估血供并协助管道的构建。比较实施导管血管评价前后的漏率，介绍术中胃导管血管评价后，我们注意到吻合口瘘的发生率从最初60例患者的20%急剧下降到0%术中应用吲哚菁绿色荧光成像和多普勒检查胃导管，食管切除术后的辅助重建允许增强导管的构造，从而最大化吻合的血液供应。实践中的这一变化与吻合口漏发生率的显著降低相关。
Anastomotic leak following esophagectomy is associated with significant morbidity and mortality. A major factor determining anastomotic success is an adequate blood supply to the conduit. The aim of this study was to determine the impact of intraoperative evaluation of the conduit's vascular supply on anastomotic failure after esophagectomy.We retrospectively analyzed data from 90 consecutive patients undergoing esophagectomy with gastric conduit reconstruction. A change in surgical practice occurred after 60 cases were completed, when we introduced the use of intraoperative indocyanine green fluorescence angiography and Doppler examination to evaluate blood supply and assist in construction of the conduit. The leak rates before and after implementation of conduit vascular evaluation were compared.After the introduction of intraoperative vascular evaluation of the gastric conduit, we noted a dramatic decrease in the rate of anastomotic leak from 20 % in the first 60 patients to 0 % in the succeeding 30 patients.Intraoperative vascular evaluation with indocyanine green fluorescence imaging and Doppler examination of the gastric conduit used to assist reconstruction after esophagectomy allows for enhanced construction of the conduit that maximizes blood supply to the anastomosis. This change in practice was associated with a significant reduction in anastomotic leak rate.