PDF(Pubmed)
Abstract：
UNASSIGNED: Indocyanine green (ICG) fluorescence angiography (FA) is used for several purposes in general surgery, but its use in bariatric surgery is still debated. The objective of the present pilot study is to evaluate the intraoperative utility of ICG-FA during bariatric surgery in order to focus future research on a reliable tool to reduce the postoperative leak rate.
UNASSIGNED: Thirteen patients (4 men, 30.8%, 9 women, 69.2%) with median age of 52 years (confidence interval, CI, 95% 46.2-58.7 years) and preoperative median body mass index of 42.6 kg/m2 (CI, 95% 36 to 49.3 kg/m2) underwent bariatric surgery with ICG-FA in our center. Three mL of ICG diluted with 10 cc sterile water were intravenously injected after gastric tube creation during laparoscopic sleeve gastrectomy (LSG) and after the gastric pouch and gastro-jejunal anastomosis creation during laparoscopic gastric by-pass (LGB). For the ICG-FA, Karl Storz Image 1S D-Light system (Karl Storz Endoscope GmbH & C. K., Tuttlingen, Germany) placed at a fixed distance of 5 cm from the structures of interest and zoomed vision modality were used to identify the vascular supply. The perfusion pattern was assessed by the surgical team according to a score. The score ranged from 1 (poor vascularization) to 5 (excellent vascularization) based on the intensity and timing of fluorescence of the vascularized structures.
UNASSIGNED: Fom January 2021 to February 2022, six patients underwent LSG (46.2%), three patients underwent LGB (23.1%), and four patients underwent re-do LGB after LSG (30.8%). No adverse effects to ICG were observed. In 11 patients (84.6%) ICG-FA score was 5. During two laparoscopic re-do LGB, the vascular supply was not satisfactory (score 2/5) and the surgical strategy was changed based on ICG-FA (15.4%). At a median follow-up of five months postoperatively, leaks did not occur in any case.
UNASSIGNED: ICG-FA during bariatric surgery is a safe, feasible and promising procedure. It could help to reduce the ischemic leak rate, even if standardization of the procedure and objective fluorescence quantification are still missing. Further prospective studies with a larger sample of patients are required to draw definitive conclusions.
UNASSIGNED: Thirteen patients (4 men, 30.8%, 9 women, 69.2%) with median age of 52 years (confidence interval, CI, 95% 46.2-58.7 years) and preoperative median body mass index of 42.6 kg/m2 (CI, 95% 36 to 49.3 kg/m2) underwent bariatric surgery with ICG-FA in our center. Three mL of ICG diluted with 10 cc sterile water were intravenously injected after gastric tube creation during laparoscopic sleeve gastrectomy (LSG) and after the gastric pouch and gastro-jejunal anastomosis creation during laparoscopic gastric by-pass (LGB). For the ICG-FA, Karl Storz Image 1S D-Light system (Karl Storz Endoscope GmbH & C. K., Tuttlingen, Germany) placed at a fixed distance of 5 cm from the structures of interest and zoomed vision modality were used to identify the vascular supply. The perfusion pattern was assessed by the surgical team according to a score. The score ranged from 1 (poor vascularization) to 5 (excellent vascularization) based on the intensity and timing of fluorescence of the vascularized structures.
UNASSIGNED: Fom January 2021 to February 2022, six patients underwent LSG (46.2%), three patients underwent LGB (23.1%), and four patients underwent re-do LGB after LSG (30.8%). No adverse effects to ICG were observed. In 11 patients (84.6%) ICG-FA score was 5. During two laparoscopic re-do LGB, the vascular supply was not satisfactory (score 2/5) and the surgical strategy was changed based on ICG-FA (15.4%). At a median follow-up of five months postoperatively, leaks did not occur in any case.
UNASSIGNED: ICG-FA during bariatric surgery is a safe, feasible and promising procedure. It could help to reduce the ischemic leak rate, even if standardization of the procedure and objective fluorescence quantification are still missing. Further prospective studies with a larger sample of patients are required to draw definitive conclusions.
摘要：
■吲哚菁绿（ICG）荧光血管造影术（FA）在普外科中用于多种目的，但它在减肥手术中的使用仍有争议。本初步研究的目的是评估ICG-FA在减肥手术中的术中实用性，以便将未来的研究重点放在降低术后渗漏率的可靠工具上。
■13名患者（4名男性，30.8%,9女人，69.2%)，中位年龄为52岁(置信区间，CI，95％46.2-58.7岁）和术前中位体重指数为42.6kg/m2（CI，95％36至49.3kg/m2）在我们中心接受了ICG-FA的减肥手术。在腹腔镜袖状胃切除术（LSG）期间创建胃管后以及在腹腔镜胃旁路（LGB）期间创建胃袋和胃空肠吻合后，静脉注射3mL用10cc无菌水稀释的ICG。对于ICG-FA，卡尔·斯托兹图像1SD-Light系统(卡尔·斯托兹内窥镜有限公司，Tuttlingen,德国）放置在距目标结构5cm的固定距离处，并使用放大的视觉模态来识别血管供应。手术团队根据评分评估灌注模式。基于血管化结构的荧光强度和时间,评分范围从1(差的血管化)到5(优异的血管化)。
■从2021年1月到2022年2月，有6名患者接受了LSG（46.2％），3例患者接受LGB（23.1％），4例患者在LSG后再次行LGB(30.8%).未观察到对ICG的不利影响。11例患者(84.6%)ICG-FA评分为5。在两次腹腔镜重做LGB期间，血管供应不令人满意(评分2/5),根据ICG-FA改变了手术策略(15.4%).在术后5个月的中位随访中，在任何情况下都没有发生泄漏。
■减肥手术期间的ICG-FA是安全的，可行和有前途的程序。它可以帮助降低缺血性渗漏率，即使程序的标准化和客观荧光定量仍然缺失。需要对更大样本的患者进行进一步的前瞻性研究才能得出明确的结论。
■13名患者（4名男性，30.8%,9女人，69.2%)，中位年龄为52岁(置信区间，CI，95％46.2-58.7岁）和术前中位体重指数为42.6kg/m2（CI，95％36至49.3kg/m2）在我们中心接受了ICG-FA的减肥手术。在腹腔镜袖状胃切除术（LSG）期间创建胃管后以及在腹腔镜胃旁路（LGB）期间创建胃袋和胃空肠吻合后，静脉注射3mL用10cc无菌水稀释的ICG。对于ICG-FA，卡尔·斯托兹图像1SD-Light系统(卡尔·斯托兹内窥镜有限公司，Tuttlingen,德国）放置在距目标结构5cm的固定距离处，并使用放大的视觉模态来识别血管供应。手术团队根据评分评估灌注模式。基于血管化结构的荧光强度和时间,评分范围从1(差的血管化)到5(优异的血管化)。
■从2021年1月到2022年2月，有6名患者接受了LSG（46.2％），3例患者接受LGB（23.1％），4例患者在LSG后再次行LGB(30.8%).未观察到对ICG的不利影响。11例患者(84.6%)ICG-FA评分为5。在两次腹腔镜重做LGB期间，血管供应不令人满意(评分2/5),根据ICG-FA改变了手术策略(15.4%).在术后5个月的中位随访中，在任何情况下都没有发生泄漏。
■减肥手术期间的ICG-FA是安全的，可行和有前途的程序。它可以帮助降低缺血性渗漏率，即使程序的标准化和客观荧光定量仍然缺失。需要对更大样本的患者进行进一步的前瞻性研究才能得出明确的结论。
