Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
Ann Thorac Surg. 2010 Oct;90(4):1121-6. doi: 10.1016/j.athoracsur.2010.06.003.
Ischemic conditioning of the gastric conduit is considered as a possible approach to improve perfusion of the gastric tube after esophagectomy. The aim of this study was to assess the impact of ischemic conditioning on gastric microcirculation in a clinical setting.
Nineteen patients with an esophageal carcinoma were included. In a first laparoscopic procedure, the stomach was devascularized by complete gastric mobilization including ligation of the left gastric artery ("laparoscopic gastrolysis"). After a delay of 4 to 5 days, all patients underwent a transthoracic esophagectomy and reconstruction with the prepared gastric conduit (Ivor-Lewis). Mucosal oxygen saturation (MOS, sulfur dioxide in %) was quantitatively measured from the endoluminal side in well-defined areas of the antrum, corpus, and fundus using a tissue spectrometer located at the tip of a microprobe (LEA, Medizintechnik, Giessen, Germany). Under general anesthesia, sulfur dioxide measurement I was taken before, and measurement II after laparoscopic gastric mobilization; measurement III was done before esophagectomy and reconstruction 4 to 5 days later.
Before laparoscopic mobilization of the stomach the median MOS of the fundus was 72% (range, 49% to 86%). The MOS significantly decreased after devascularization of the stomach (median MOS, 38%; range, 9% to 86%). After 4 to 5 days, MOS almost recovered to values observed before gastric mobilization (median MOS, 62%; range, 48% to 85%). Compared with the fundus, no significant sulphur dioxide changes were detected in the corpus and antrum.
This study demonstrates that ischemic conditioning influences microcirculation of the gastric conduit and improves MOS in the anastomotic region at the time of reconstruction.
胃管的缺血预处理被认为是改善食管癌手术后胃管灌注的一种可能方法。本研究旨在评估在临床环境中缺血预处理对胃微循环的影响。
纳入 19 例食管癌患者。在首次腹腔镜手术中，通过完全胃动员使胃去血管化，包括结扎左胃动脉（“腹腔镜胃松解术”）。4-5 天后，所有患者均行经胸食管切除术和预制胃管（Ivor-Lewis）重建。使用位于微探针尖端的组织光谱仪（德国吉森的 LEA，Medizintechnik），从内腔侧定量测量胃窦、胃体和胃底的黏膜氧饱和度（MOS，以 %表示）。在全身麻醉下，测量 I 在腹腔镜胃动员前进行，测量 II 在腹腔镜胃动员后进行；测量 III 在 4-5 天后行食管切除术和重建前进行。
在腹腔镜胃动员前，胃底的中位数 MOS 为 72%（范围，49%-86%）。胃去血管化后 MOS 显著降低（中位数 MOS，38%；范围，9%-86%）。4-5 天后，MOS 几乎恢复到胃动员前观察到的水平（中位数 MOS，62%；范围，48%-85%）。与胃底相比，胃体和胃窦的二氧化硫变化无统计学意义。
本研究表明，缺血预处理影响胃管的微循环，并在重建时改善吻合区的 MOS。
