幽門側胃切除後の膵体尾部切除における残胃血流評価として術中indocyanine green蛍光造影を行った1例
幽門側胃切除後の膵体尾部切除・脾摘術において，残胃温存の可否に関していまだ結論は出ていない．近年，術中indocyanine green（以下，ICGと略記）蛍光造影が臓器血流評価に有用とする報告が増えている．今回，我々は幽門側胃切除既往症例の膵体尾部切除・脾摘術において，術中ICG蛍光造影による残胃血流評価を行った後に，残胃を温存した症例を経験したので報告する．症例は59歳の男性で，25歳時に胃潰瘍に対して幽門側胃切除を施行された．心窩部痛を契機に膵体部癌を指摘された．術前画像診断では左右胃動静脈と右胃大網動静脈は前回手術時に切離されていると思われた．左胃大網動静脈，短胃動静脈，脾動静脈を切...
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| Published in | 日本消化器外科学会雑誌 Vol. 47; no. 12; pp. 762 - 767 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本消化器外科学会
2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 |
| DOI | 10.5833/jjgs.2014.0042 |
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| Abstract | 幽門側胃切除後の膵体尾部切除・脾摘術において，残胃温存の可否に関していまだ結論は出ていない．近年，術中indocyanine green（以下，ICGと略記）蛍光造影が臓器血流評価に有用とする報告が増えている．今回，我々は幽門側胃切除既往症例の膵体尾部切除・脾摘術において，術中ICG蛍光造影による残胃血流評価を行った後に，残胃を温存した症例を経験したので報告する．症例は59歳の男性で，25歳時に胃潰瘍に対して幽門側胃切除を施行された．心窩部痛を契機に膵体部癌を指摘された．術前画像診断では左右胃動静脈と右胃大網動静脈は前回手術時に切離されていると思われた．左胃大網動静脈，短胃動静脈，脾動静脈を切離した後のICG蛍光造影にて，食道側や小網側から残胃血流が維持されていることを確認し，残胃を温存した．術後軽度の膵液瘻を認めたものの，11病日に軽快退院した． |
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| AbstractList | 幽門側胃切除後の膵体尾部切除・脾摘術において，残胃温存の可否に関していまだ結論は出ていない．近年，術中indocyanine green（以下，ICGと略記）蛍光造影が臓器血流評価に有用とする報告が増えている．今回，我々は幽門側胃切除既往症例の膵体尾部切除・脾摘術において，術中ICG蛍光造影による残胃血流評価を行った後に，残胃を温存した症例を経験したので報告する．症例は59歳の男性で，25歳時に胃潰瘍に対して幽門側胃切除を施行された．心窩部痛を契機に膵体部癌を指摘された．術前画像診断では左右胃動静脈と右胃大網動静脈は前回手術時に切離されていると思われた．左胃大網動静脈，短胃動静脈，脾動静脈を切離した後のICG蛍光造影にて，食道側や小網側から残胃血流が維持されていることを確認し，残胃を温存した．術後軽度の膵液瘻を認めたものの，11病日に軽快退院した． |
| Author | 坂口, 孝宣 森田, 剛文 今野, 弘之 柴崎, 泰 海野, 直樹 木内, 亮太 武田, 真 菊池, 寛利 鈴木, 淳司 平出, 貴乗 |
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| References | 6) Kondo S, Katoh H, Hirano S, Ambo Y, Tanaka E, Maeyama Y, et al. Ischemic gastropathy after distal pancreatectomy with celiac axis resection. Surg Today. 2004;34(4):337–340. 8) 西原 一善，矢吹 慶，阿部 祐治，松永 浩明，中野 徹，光山 昌珠．幽門側胃切除後の膵腫瘍に対する術式の工夫―特に胃切除後の膵体尾部切除について―．日本肝胆膵外科学会・学術集会プログラム・抄録集23回．2011. p. 479. 4) Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg. 1999 May;229(5):693–698; discussion 8-700. 17) Sakaguchi T, Suzuki A, Unno N, Morita Y, Oishi K, Fukumoto K, et al. Bile leak test by indocyanine green fluorescence images after hepatectomy. Am J Surg. 2010 Jul;200(1):e19–23. 5) Isabella V, Marotta E, Bianchi F. Ischemic necrosis of proximal gastric remnant following subtotal gastrectomy with splenectomy. J Surg Oncol. 1984 Feb;25(2):124–132. 18) Morita Y, Sakaguchi T, Unno N, Shibasaki Y, Suzuki A, Fukumoto K, et al. Detection of hepatocellular carcinomas with near-infrared fluorescence imaging using indocyanine green: its usefulness and limitation. Int J Clin Oncol. 2013 Apr;18(2):232–241. 13) Ackland G, Grocott MP, Mythen MG. Understanding gastrointestinal perfusion in critical care: so near, and yet so far. Crit Care. 2000;4(5):269–281. 12) Tsekov C, Belyaev O, Tcholakov O, Tcherveniakov A. Intraoperative Doppler assessment of gastric tube perfusion in esophagogastroplasty. J Surg Res. 2006 May;132(1):98–103. 16) Unno N, Inuzuka K, Suzuki M, Yamamoto N, Sagara D, Nishiyama M, et al. Preliminary experience with a novel fluorescence lymphography using indocyanine green in patients with secondary lymphedema. J Vasc Surg. 2007 May;45(5):1016–1021. 9) 今村 将史，木村 康利，目黒 誠，中野 正一郎，三浦 亮，中村 幸雄，ほか．幽門側胃切除既往症例に対する尾側膵切除術の経験．日本肝胆膵外科学会・学術集会プログラム・抄録集24回．2012. p. 369. 19) Kamp MA, Slotty P, Turowski B, Etminan N, Steiger HJ, Hanggi D, et al. Microscope-integrated quantitative analysis of intraoperative indocyanine green fluorescence angiography for blood flow assessment: first experience in 30 patients. Neurosurgery. 2012 Mar;70(1 Suppl Operative):65–73; discussion 73-4. 2) Unno N, Suzuki M, Yamamoto N, Inuzuka K, Sagara D, Nishiyama M, et al. Indocyanine green fluorescence angiography for intraoperative assessment of blood flow: a feasibility study. Eur J Vasc Endovasc Surg. 2008 Feb;35(2):205–207. 10) Takahashi H, Nara S, Ohigashi H, Sakamoto Y, Gotoh K, Esaki M, et al. Is preservation of the remnant stomach safe during distal pancreatectomy in patients who have undergone distal gastrectomy? World J Surg. 2013 Feb;37(2):430–436. 3) 日本膵臓学会編．膵癌取扱い規約．第6版．東京：金原出版；2009. 72p. 14) Imamura H, Sano K, Sugawara Y, Kokudo N, Makuuchi M. Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test. J Hepatobiliary Pancreat Surg. 2005;12(1):16–22. 1) Rubens FD, Ruel M, Fremes SE. A new and simplified method for coronary and graft imaging during CABG. Heart Surg Forum. 2002;5(2):141–144. 7) 三瀬 祥弘，田中 信孝，古屋 隆俊，野村 幸博，松本 順，永井 元樹，ほか．幽門側胃切除後膵体部インスリノーマに対して膵温存膵体尾部切除を施行した一例．日本臨床外科学会雑誌．2010;71(Suppl):793. 15) Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V. Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery. 2003 Jan;52(1):132–139; discussion 9. 11) Larsen PN, Moesgaard F, Naver L, Rosenberg J, Gottrup F, Kirkegaard P, et al. Gastric and colonic oxygen tension measured with a vacuum-fixed oxygen electrode. Scand J Gastroenterol. 1991 Apr;26(4):409–418. |
| References_xml | – reference: 2) Unno N, Suzuki M, Yamamoto N, Inuzuka K, Sagara D, Nishiyama M, et al. Indocyanine green fluorescence angiography for intraoperative assessment of blood flow: a feasibility study. Eur J Vasc Endovasc Surg. 2008 Feb;35(2):205–207. – reference: 3) 日本膵臓学会編．膵癌取扱い規約．第6版．東京：金原出版；2009. 72p. – reference: 18) Morita Y, Sakaguchi T, Unno N, Shibasaki Y, Suzuki A, Fukumoto K, et al. Detection of hepatocellular carcinomas with near-infrared fluorescence imaging using indocyanine green: its usefulness and limitation. Int J Clin Oncol. 2013 Apr;18(2):232–241. – reference: 10) Takahashi H, Nara S, Ohigashi H, Sakamoto Y, Gotoh K, Esaki M, et al. Is preservation of the remnant stomach safe during distal pancreatectomy in patients who have undergone distal gastrectomy? World J Surg. 2013 Feb;37(2):430–436. – reference: 5) Isabella V, Marotta E, Bianchi F. Ischemic necrosis of proximal gastric remnant following subtotal gastrectomy with splenectomy. J Surg Oncol. 1984 Feb;25(2):124–132. – reference: 6) Kondo S, Katoh H, Hirano S, Ambo Y, Tanaka E, Maeyama Y, et al. Ischemic gastropathy after distal pancreatectomy with celiac axis resection. Surg Today. 2004;34(4):337–340. – reference: 14) Imamura H, Sano K, Sugawara Y, Kokudo N, Makuuchi M. Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test. J Hepatobiliary Pancreat Surg. 2005;12(1):16–22. – reference: 1) Rubens FD, Ruel M, Fremes SE. A new and simplified method for coronary and graft imaging during CABG. Heart Surg Forum. 2002;5(2):141–144. – reference: 19) Kamp MA, Slotty P, Turowski B, Etminan N, Steiger HJ, Hanggi D, et al. Microscope-integrated quantitative analysis of intraoperative indocyanine green fluorescence angiography for blood flow assessment: first experience in 30 patients. Neurosurgery. 2012 Mar;70(1 Suppl Operative):65–73; discussion 73-4. – reference: 12) Tsekov C, Belyaev O, Tcholakov O, Tcherveniakov A. Intraoperative Doppler assessment of gastric tube perfusion in esophagogastroplasty. J Surg Res. 2006 May;132(1):98–103. – reference: 8) 西原 一善，矢吹 慶，阿部 祐治，松永 浩明，中野 徹，光山 昌珠．幽門側胃切除後の膵腫瘍に対する術式の工夫―特に胃切除後の膵体尾部切除について―．日本肝胆膵外科学会・学術集会プログラム・抄録集23回．2011. p. 479. – reference: 11) Larsen PN, Moesgaard F, Naver L, Rosenberg J, Gottrup F, Kirkegaard P, et al. Gastric and colonic oxygen tension measured with a vacuum-fixed oxygen electrode. Scand J Gastroenterol. 1991 Apr;26(4):409–418. – reference: 13) Ackland G, Grocott MP, Mythen MG. Understanding gastrointestinal perfusion in critical care: so near, and yet so far. Crit Care. 2000;4(5):269–281. – reference: 15) Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V. Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery. 2003 Jan;52(1):132–139; discussion 9. – reference: 17) Sakaguchi T, Suzuki A, Unno N, Morita Y, Oishi K, Fukumoto K, et al. Bile leak test by indocyanine green fluorescence images after hepatectomy. Am J Surg. 2010 Jul;200(1):e19–23. – reference: 4) Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg. 1999 May;229(5):693–698; discussion 8-700. – reference: 16) Unno N, Inuzuka K, Suzuki M, Yamamoto N, Sagara D, Nishiyama M, et al. Preliminary experience with a novel fluorescence lymphography using indocyanine green in patients with secondary lymphedema. J Vasc Surg. 2007 May;45(5):1016–1021. – reference: 7) 三瀬 祥弘，田中 信孝，古屋 隆俊，野村 幸博，松本 順，永井 元樹，ほか．幽門側胃切除後膵体部インスリノーマに対して膵温存膵体尾部切除を施行した一例．日本臨床外科学会雑誌．2010;71(Suppl):793. – reference: 9) 今村 将史，木村 康利，目黒 誠，中野 正一郎，三浦 亮，中村 幸雄，ほか．幽門側胃切除既往症例に対する尾側膵切除術の経験．日本肝胆膵外科学会・学術集会プログラム・抄録集24回．2012. p. 369. |
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| SubjectTerms | ICG蛍光造影 残胃血流 膵体尾部切除 |
| Title | 幽門側胃切除後の膵体尾部切除における残胃血流評価として術中indocyanine green蛍光造影を行った1例 |
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