Alfabet Charles, Montero Edna Frasson de Souza, Paes Leme Luís Fernando, Higashi Viviane S, Sallum Fo Celso F C, Fagundes Djalma José, Gomes Paulo Oliveira
Disciplina de Técnica Operatória e Cirurgia Experimental, Departamento de Cirurgia, Universidade Federal de São Paulo, São Paulo, Brazil.
Microsurgery. 2003;23(5):513-6. doi: 10.1002/micr.10164.
Occult ischemia of the mobilized stomach is usually related to the dehiscence of an esophagogastric anastomosis. The principle of ischemic conditioning was studied to verify its clinic use. This study aims to evaluate progressively the tissue perfusion of the stomach in ischemic conditioning, establishing the best moment for gastric transposition. Twenty-four male EPM-1 Wistar rats were used, which also underwent partial desvacularization of the stomach by ligature of the left gastric vessels. Tissue perfusion was measured through flowmetry by laser Doppler (tissue perfusion unit; TPU) in the antrum (10 mm distal from the cardiac region). This measurement was done before (baseline) and immediately after the ligature, and on different postoperative days (POD) (days 3, 7, 10, and 14). A statistical analysis was done with nonparametric tests (P <or= 0.05). The mean value (+/-SD) of the gastric perfusion, during the whole study period, was 88 +/- 6 (baseline), 23 +/- 5 (postligature), 31 +/- 5 (3rd POD), 55 +/- 4 (7th POD), 71 +/- 16 (10th POD), and 84 +/- 6 (14th POD), respectively. Perfusion immediately after the artery ligature was significantly lower (74%) than the baseline of the gastric perfusion; therefore, in the following days, tissue perfusion increased progressively (35%, 63%, 81%, and 96%, respectively). The flowmetry of the stomach reached basal values in the 14th POD of desvascularization, suggesting that this would the best day to perform a gastric transposition. However, on the 10th POD, good tissue perfusion was observed. The extrapolation from these data to the clinic could improve the results of esophagogastric anastomosis.
游离胃的隐匿性缺血通常与食管胃吻合口裂开有关。对缺血预处理的原理进行了研究，以验证其临床应用价值。本研究旨在逐步评估缺血预处理中胃的组织灌注情况，确定胃转位的最佳时机。选用24只雄性EPM-1 Wistar大鼠，通过结扎胃左血管对胃进行部分去血管化处理。采用激光多普勒血流仪（组织灌注单位；TPU）在胃窦（距贲门区远端10mm处）测量组织灌注。该测量在结扎前（基线）、结扎后即刻以及术后不同天数（术后第3、7、10和14天）进行。采用非参数检验进行统计分析（P≤0.05）。在整个研究期间，胃灌注的平均值（±标准差）分别为88±6（基线）、23±5（结扎后）、31±5（术后第3天）、55±4（术后第7天）、71±16（术后第10天）和84±6（术后第14天）。动脉结扎后即刻的灌注显著低于胃灌注基线（降低74%）；因此，在随后的几天里，组织灌注逐渐增加（分别增加35%、63%、81%和96%）。去血管化术后第14天，胃血流仪测量值达到基础值，提示这是进行胃转位的最佳时机。然而，在术后第10天，观察到良好的组织灌注。将这些数据外推至临床可能会改善食管胃吻合术的结果。
