胸腔导管的近红外可视化和先发制人结扎有效地减少了微创食管切除术后的Chyle泄漏发生率
The Near-Infrared Visualization and Preemptive Ligation of the Thoracic Duct Effectively Reduce the Chyle Leak Incidence After Minimally Invasive Esophagectomy
影响因子:6.40000
分区:医学1区 Top / 外科1区
发表日期:2024 Nov 01
作者:
Francesco Puccetti, Lorenzo Cinelli, Lavinia A Barbieri, Davide Socci, Di Serio Clelia, Francesco De Cobelli, Ugo Elmore, Riccardo Rosati,
摘要
本研究的目的是评估吲哚氨酸绿（ICG）引导的淋巴术（ICG-LG）在食管切除术后降低Chyle泄漏（CL）的发生率（CL）的有效性。治hothorax可能会严重影响食管癌症手术，以及最大程度地控制肌肉癌（Td wisdracty）的preptive癌癌症。术中ICG-LG最近已嵌入最低侵入性的食管切除术，以促进TD检测和先发制人的结扎。此回顾性分析包括连续的患者，这些患者在2018年1月8日与Tertiary Centry contryment的癌症中进行了最低侵入性的Ivor Ivor Lewis lewis lewis lewis lewis lewis cophagy术。连接和切除。 2021年1月以后接受治疗的所有患者均接受了ICG-LG进行TD鉴定和连接（ICG组），并与以前的系列（NO-ICG组）进行了比较。主要结果是术后CL的发生率，而单变量和向后的逐步多变量逻辑回归模型被进行以识别相关因素。在包括320名患者（151例）（ICG组）之前，将ICG-LG提交给ICG-LG。两组都具有相似的特征，除了新辅助治疗（P <0.001）和术前合并症（p = 0.045）。术中ICG-LG显着降低了术后CL的发生率（11.8％vs 4.6％，p = 0.026），并且与住院时间中位长度较短（13 vs 9 d，p = 0.006）显着相关。然而，ICG-LG后CL更可能需要修复重新手术（P = 0.050）。术中ICG-LG在总微创食管切除术后CL的速率明显降低，因此，应将其定期嵌入到高磁体中心的高层外科手术技术中，以供食管癌癌。
Abstract
The aim of the present study is to assess the effectiveness of indocyanine-green (ICG)-guided lymphography (ICG-Lg) in reducing the incidence of chyle leak (CL) after esophagectomy.Chylothorax may severely impact esophageal cancer surgery, and the pre-emptive ligation of the thoracic duct (TD) is the most widespread control of this complication. Intraoperative ICG-Lg has been recently embedded in minimally invasive esophagectomy to facilitate TD detection and pre-emptive ligation.This retrospective analysis included consecutive patients who underwent minimally invasive Ivor Lewis esophagectomy for cancer at a tertiary referral center between January 2018 and August 2023. Patients were routinely submitted to extended lymphadenectomy with TD ligation and removal. All patients treated after January 2021 underwent ICG-Lg for TD identification and ligation (ICG group) and compared with the previous series (no-ICG group). The primary outcome was the incidence of postoperative CL, while univariate and backward stepwise multivariate logistic regression models were performed to identify associated factors.After including 320 patients, 151 (ICG group) were submitted to ICG-Lg before the pre-emptive TD ligation. Both groups presented similar characteristics, except for neoadjuvant therapy ( P <0.001) and preoperative comorbidities ( P =0.045). Intraoperative ICG-Lg significantly reduced the incidence of postoperative CL (11.8% vs 4.6%, P =0.026) and was significantly associated with shorter median length of hospital stay (13 vs 9 d, P =0.006). However, CL after ICG-Lg was more likely to require repairing reoperation ( P =0.050).Intraoperative ICG-Lg demonstrated significantly lower rates of CL after total minimally invasive esophagectomy and, therefore, it should be routinely embedded in the standardized surgical technique of high-volume centers for esophageal cancer.