Agossou-Voyème A K, Hureau J, Germain M
Laboratoire d'Anatomie, UER Biomédicale des Saint-Pères, Paris, France.
Surg Radiol Anat. 1990;12(4):247-57. doi: 10.1007/BF01623698.
The rich vascularisation of the stomach is well known and the remarkable tolerance of the organ to vascular ligatures has been emphasised. However, some clinical observations as well as more and more detailed anatomical studies suggest some modification of this classical concept, especially when operating on the viscus. The aim of this work was to evaluate particularly the importance of parietal ischemia which follows hyperselective vagotomy and the more recent anterior seromyotomy, on the one hand, and the gastrolysis that precedes gastro-esophagoplasty after esophagectomy or circular pharyngolaryngectomy on the other hand. The stomachs of 40 unembalmed adult cadavers were studied by angiography in various ways, according to the operation which was being considered. The findings indicated that hyperselective vagotomy caused an avascular band 2 cm wide along that part of the lesser curve affected by the surgical intervention, and that anterior seromyotomy (allowing for some technical artifacts) caused almost no parietal ischemia, and lastly, that the ischemia from gastro-esophagoplasty varied according to the technique used. Useful conclusions, supported by numerous illustrations, will allow the surgeon to define better the vascular requirements when choosing the procedure to be used, taking account of the clinical situation.
胃丰富的血管分布广为人知，并且该器官对血管结扎的显著耐受性也已得到强调。然而，一些临床观察以及越来越详细的解剖学研究表明，这一经典概念需要有所修正，尤其是在对该脏器进行手术时。这项研究的目的一方面是特别评估高选择性迷走神经切断术以及最近的前肌层切开术之后壁层缺血的重要性，另一方面是评估食管切除术后或环状咽喉切除术后胃食管成形术前胃松解术导致的壁层缺血的重要性。根据所考虑的手术方式，通过多种血管造影方法对40具未防腐处理的成年尸体的胃进行了研究。研究结果表明，高选择性迷走神经切断术会在受手术干预影响的小弯部分形成一条2厘米宽的无血管带，前肌层切开术（考虑到一些技术假象）几乎不会导致壁层缺血，最后，胃食管成形术导致的缺血因所使用的技术而异。大量插图支持的有用结论将使外科医生在选择手术方式时，能够根据临床情况更好地确定血管需求。
