川口 雄之亮

33歳男性。意識障害と呂律障害を主訴とした。臨床経過および精査により、短腸症候群に伴うD-乳酸アシドーシスと診断された。整腸剤の投与や抗菌薬による治療が行われたが、症状は繰り返され、頻回の入院を要したことから、母親をドナーとした糞便移植を行うこととなった。前処置の段階で症状は改善がみられたが、移植5日後にはD-乳酸アシドーシスの再燃が認められた。そこで、前処置による腸管洗浄が症状の緩和に有効と考え、数日おきにポリエチレングリコール製剤の投与を行った結果、症状は緩和した。その後、中心静脈カテーテルを再挿入後、中心静脈栄養を再開したところ、再開後はD-乳酸アシドーシスの再燃なく、4年が経過している。

PURPOSE: This pilot study evaluated indocyanine green-guided near-infrared fluorescence (ICG-NIRF) imaging of testicular blood flow to predict long-term testicular atrophy after testicular torsion (TT) surgery. METHODS: The subjects of this retrospective study were patients who underwent surgery for TT at our hospital between December, 2020 and July, 2022. After detorsion, testicular blood flow was evaluated by ICG-NIRF imaging and classified into three categories: fluorescence detected, no fluorescence detected, and fluorescence detected only in the tunica albuginea vessels. Testicular volume was measured by ultrasonography up to 12 months after surgery to evaluate long-term outcomes. RESULTS: Twelve patients were included in this analysis. We found a 100% correlation between the absence of ICG-NIRF signals and subsequent testicular atrophy. In three patients without an ICG-NIRF signal, the median testis size 12 months postoperatively was significantly smaller (16.5% of the contralateral testis; range 13-20%) than that in six patients with an ICG-NIRF signal (96%; 89-115%) (p = 0.013). Mild atrophy (74.5%; 73-76%) was also observed in the three patients for whom an ICG-NIRF signal was detected only in the tunica albuginea vessels. CONCLUSIONS: Our pilot study highlights the potential of ICG-NIRF imaging as a prognostic tool for guiding surgical decision-making for patients with TT, by predicting postoperative testicular atrophy.