Indocyanine green fluorescence angiography of the reconstructed gastric tube during esophagectomy: efficacy of the 90-second rule
Indocyanine green fluorescence angiography of the reconstructed gastric tube during esophagectomy: efficacy of the 90-second rule
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DOI：
10.1093/dote/doy052
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发表时间：
2018-12-01
影响因子：
2.6
通讯作者：
Ishida, H.
中科院分区：
文献类型：
--
作者：
Kumagai, Y.;Hatano, S.;Ishida, H.
通过使用吲哚菁绿荧光（ICG）血管造影检查食管切除术中重建的胃管，我们建立了“90秒规则”来确认吻合部位血液灌注良好。我们使用ICG荧光血管造影检查了70例连续行食管切除术并胃管重建的患者的手术结果（吻合口漏率）。所有吻合都在ICG荧光血管造影增强所需时间少于90秒的区域进行（即在90秒规则内）。18例胃管尖端强化时间超过60秒，参照ICG荧光血管造影确定吻合部位，切除灌注不足区域，显著缩短胃管尖端强化时间中位数，由95.5（60.0 ~ 204.0）秒缩短至41.0（9.0 ~ 77.0）秒（P < 0.001）。在三个病例中，在需要60秒以上ICG增强的部位进行吻合。一例ICG增强时间为77秒，发生轻微吻合口漏。吻合口漏的总发生率为1.4%。如果在ICG荧光血管造影显示增强的区域在60秒内进行吻合，则重建胃管血流充足。切除强化时间超过90秒的区域可避免胃管坏死。90秒规则是确定吻合部位的一种安全有效的方法。
By examining the reconstructed gastric tube during esophagectomy using indocyanine green fluorescence (ICG) angiography, we have established a '90-second rule' to confirm good blood perfusion at the anastomosis site. We examined the surgical outcome (rate of anastomotic leakage) of 70 consecutive patients who underwent esophagectomy with gastric tube reconstruction using ICG fluorescence angiography. All of the anastomoses were made in the area where less than 90 seconds was needed for enhancement using ICG fluorescence angiography (i.e. within the 90-second rule). In 18 cases for which the time until enhancement of the gastric tube tip exceeded 60 seconds, the anastomosis site was decided by reference to the ICG fluorescence angiogram, and the hypoperfused area was excised, and this significantly shortened the median time until enhancement of the gastric tube tip from 95.5 (60.0-204.0) seconds to 41.0 (9.0-77.0) seconds (P < 0.001). In three cases, the anastomosis was made at the site where more than 60 seconds was needed for ICG enhancement. In one case where ICG enhancement had taken 77 seconds, minor anastomotic leakage occurred. The overall rate of anastomotic leakage in this series was 1.4%. Blood flow in the reconstructed gastric tube is sufficient if the anastomosis is made in the area where ICG fluorescence angiography demonstrates enhancement within 60 seconds. Gastric tube necrosis can be avoided if the area showing an enhancement time exceeding 90 seconds is excised. The 90-second rule is a safe and effective method for deciding the site of anastomosis.