Impact of indocyanine green-fluorescence imaging on distal pancreatectomy with celiac axis resection combined with reconstruction of the left gastric artery
Impact of indocyanine green-fluorescence imaging on distal pancreatectomy with celiac axis resection combined with reconstruction of the left gastric artery
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DOI：
10.1016/j.hpb.2018.09.023
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发表时间：
2019-05-01
期刊：
影响因子：
2.9
通讯作者：
Saiura, Akio
中科院分区：
文献类型：
--
作者：
Oba, Atsushi;Inoue, Yosuke;Saiura, Akio
背景资料：我们先前报道了胰尾切除术联合腹腔干切除术（DP-CAR）和胃左动脉（LGA）重建术预防缺血性胃病的有效性。为了评估重建质量，我们进行了术中血管造影与吲哚菁绿色（ICG）-fluorescence imaging.Methods：2014年至2017年，21例计划进行DP-CAR与LGA重建的连续患者入选了这项前瞻性、探索性单臂研究。LGA重建后，术中血管造影显示连续的动脉血流通过吻合口，并逐渐增加胃内组织灌注。在其余18例患者中，我们在初始LGA重建后获得了11例良好的血流和7例较差的血流。血流不畅的7例患者中，5例行LGA再吻合，3例恢复良好血流。最终血流良好组B/C级DGE的发生率为14%（2/14），血流不良组为75%（3/4）（p = 0.019）。缺血性胃病发生在两名患者（50%）在流动性差组（p = 0.039），包括一个胃perforation.Discussion：我们的数据表明，术中血管造影与ICG荧光成像可以评估重建质量，从而有助于改善短期结果的DP-CAR LGA重建。
Background: We previously reported the usefulness of distal pancreatectomy with celiac axis resection (DP-CAR) with left gastric artery (LGA) reconstruction to prevent ischemic gastropathy. To evaluate the reconstruction quality, we performed intraoperative angiography with indocyanine green (ICG)-fluorescence imaging.Methods: 21 consecutive patients planned for DP-CAR with LGA reconstruction were enrolled in this prospective, exploratory single-arm study from 2014 to 2017. After LGA reconstruction, intraoperative angiography revealed continuous arterial flow passing through the anastomotic sites and gradually increasing tissue perfusion in the stomach.Results: Three patients were excluded. Among the remaining 18 patients, we obtained good flow in 11 patients and poor flow in 7 patients after initial LGA reconstruction. Among the seven patients with poor flow, five underwent LGA re-anastomosis, three recovered good flow. The incidence of grade B/C DGE was 14% (2/14) in the finally good flow group and 75% (3/4) in the poor flow group (p = 0.019). Ischemic gastropathy occurred in two patients (50%) in the poor flow group (p = 0.039), including one with a gastric perforation.Discussion: Our data show that intraoperative angiography with ICG-fluorescence imaging can evaluate the reconstruction quality, thus contributing to improvements in the short-term outcome of DP-CAR with LGA reconstruction.