Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Surg Endosc. 2011 May;25(5):1383-9. doi: 10.1007/s00464-010-1372-8. Epub 2010 Oct 23.
Dehiscence or leakage after bowel anastomoses is associated with high morbidity and mortality. Perfusion and local tissue oxygenation (StO2), independent of systemic oxygen saturation, are fundamental determinants of anastomotic viability. Because current technology is limited for monitoring local StO2 at bowel anastomoses, our goal was to construct a wireless pulse oximeter (WiPOX) to monitor real-time intraoperative tissue oxygenation, permitting identification of compromised anastomotic perfusion.
We have: (a) designed a handheld device capable of real-time monitoring of serosal and mucosal StO2 through endoscopic ports with wireless data transmission to standard intraoperative monitors, (b) constructed the WiPOX using materials meeting FDA regulations for intraoperative use and reuse, (c) performed accuracy testing in humans by comparing the WiPOX to standard pulse oximeters, and (d) tested WiPOX efficacy for detecting early tissue hypoxia in stomach, intestines, and kidneys in anesthetized rats and swine.
In humans, WiPOX demonstrated accuracy within 3% compared with commercially available pulse oximeters. Application of the WiPOX in rats and swine demonstrated normal serosal and mucosal StO2 and pulse rates in healthy small bowel and stomach. Within 30 s of compromised perfusion, the WiPOX detected bowel hypoxia over a wide range of oxygen saturation (p<0.005). A greater degree of hypoxia was detected in mucosal versus serosal measurements during early ischemia, despite normal appearance of tissue. The onboard sensor-processor unit permitted noninvasive pulse oximetry and integration with current intraoperative monitoring. The contact pressure-sensing head allowed for consistent, high-quality StO2 waveform readouts despite the presence of body fluids.
We have constructed, validated, and successfully tested a novel wireless pulse oximeter capable of detecting intraoperative tissue hypoxia in open or endoscopic surgery. This device will aid surgeons in detecting anastomotic vascular compromise and facilitate choosing an ideal site for bowel anastomosis by targeting well-perfused tissue with optimal healing capacity.
肠吻合口的裂开或渗漏与高发病率和死亡率相关。灌注和局部组织氧合（StO2），与全身氧饱和度无关，是吻合口存活的基本决定因素。由于目前的技术在监测肠吻合口的局部 StO2 方面受到限制，我们的目标是构建一种无线脉搏血氧仪（WiPOX）来监测术中实时组织氧合，从而识别受影响的吻合口灌注。
我们：（a）设计了一种能够通过内镜端口实时监测浆膜和黏膜 StO2 的手持设备，具有无线数据传输功能，可将数据传输至标准术中监测仪，（b）使用符合 FDA 规定的可重复使用的材料构建 WiPOX，（c）通过将 WiPOX 与标准脉搏血氧仪进行比较，在人体中进行了准确性测试，以及（d）在麻醉大鼠和猪中测试了 WiPOX 检测胃、肠和肾脏早期组织缺氧的效果。
在人体中，WiPOX 与市售脉搏血氧仪相比，准确性在 3%以内。WiPOX 在大鼠和猪中的应用表明，在健康的小肠和胃中，浆膜和黏膜的 StO2 和脉搏率正常。在灌注受损后 30 秒内，WiPOX 检测到肠缺氧的范围很广，氧饱和度（p<0.005）。尽管组织外观正常，但在早期缺血期间，黏膜测量的缺氧程度比浆膜测量的更严重。板载传感器处理单元允许进行非侵入性脉搏血氧测量，并与当前的术中监测集成。接触压力感应头允许在存在体液的情况下进行一致的、高质量的 StO2 波形读数。
我们已经构建、验证并成功测试了一种新型的无线脉搏血氧仪，该仪器能够在开放或内镜手术中检测术中组织缺氧。该设备将帮助外科医生检测吻合口血管受压，并通过靶向具有最佳愈合能力的灌注良好的组织，为肠吻合选择理想的部位提供帮助。
