Mittermair Christof, Klaus Alexander, Scheidl Stephan, Maglione Manuel, Hermann Martin, Margreiter Raimund, Nguyen Ningh, Weiss Helmut
Department of General and Transplant Surgery, Medical University Innsbruck, Innsbruck, Austria.
Am J Surg. 2008 Jul;196(1):88-92. doi: 10.1016/j.amjsurg.2007.07.025.
Ischemia may lead to leakage at the esophagogastric anastomosis after esophagectomy. The aim of this study was to investigate time dependent changes of gastric microcirculation after ischemic conditioning.
Twenty male Lewis rats were used and analyzed in 3 study groups and 1 control group. Group 1 (n = 5) underwent ligation of the left gastric artery and intravital fluorescence microscopy (IVM) on day 0; group 2 (n = 5) underwent IVM at 28 days after ligation of the LGA; and group 3 (n = 5) underwent IVM at 56 days after ligation of the LGA. The controls (n = 5) underwent sham surgery and IVM at 28 days thereafter. IVM was used to analyze gastric microcirculation by means of functional capillary density.
Ligation of the LGA immediately led to significant reduction of perfusion at the lesser (100.5 +/- 3.1 microm/mm(2) vs 220.4 +/- 7.4 microm/mm(2); P <.001) and greater curvatures (195.1 +/- 7.9 microm/mm(2) vs 234.1 +/- 9.4 microm/mm(2); P = .013). During 28 days, microcirculation at the lesser curve ameliorated (164.9 +/- 12.8 microm/mm(2)) and reached normal values after 56 days (215.8 +/- 7.4 microm/mm(2)). At the greater curve, microcirculation was improved during 4 (261.3 +/- 8 microm/mm(2)P = .039) and 8 weeks (317.9 +/- 10.3 microm/mm(2); P <.001 vs control).
Gastric microperfusion continuously improves after partial devascularization. The results support further clinical studies to optimize gastric ischemic conditioning in patients undergoing esophagectomy.
缺血可能导致食管切除术后食管胃吻合口漏。本研究的目的是探讨缺血预处理后胃微循环的时间依赖性变化。
选用20只雄性Lewis大鼠，分为3个研究组和1个对照组进行分析。第1组（n = 5）在第0天进行胃左动脉结扎和活体荧光显微镜检查（IVM）；第2组（n = 5）在胃左动脉结扎后28天进行IVM；第3组（n = 5）在胃左动脉结扎后56天进行IVM。对照组（n = 5）接受假手术，并在术后28天进行IVM。通过功能性毛细血管密度，利用IVM分析胃微循环。
胃左动脉结扎立即导致胃小弯处灌注显著降低（100.5±3.1微米/毫米²对220.4±7.4微米/毫米²；P <.001）和胃大弯处灌注显著降低（195.1±7.9微米/毫米²对234.1±9.4微米/毫米²；P =.013）。在28天内，胃小弯处的微循环有所改善（164.9±12.8微米/毫米²），并在56天后恢复到正常水平（215.8±7.4微米/毫米²）。在胃大弯处，微循环在4周（261.3±8微米/毫米²；P =.039）和8周时得到改善（317.9±10.3微米/毫米²；与对照组相比，P <.001）。
部分血管离断后胃微灌注持续改善。这些结果支持进一步开展临床研究，以优化食管癌切除术患者的胃缺血预处理。
