Diana Michele, Halvax Peter, Pop Raoul, Schlagowski Isabel, Bour Gaetan, Liu Yu-Yin, Legner Andras, Diemunsch Pierre, Geny Bernard, Dallemagne Bernard, Beaujeux Rémy, Demartines Nicolas, Marescaux Jacques
IHU Institute for Minimally Invasive Image-Guided Surgery, Strasbourg, France Physiology Institute, Research Unit on oxidative stress and mitochondria (EA 3072), University of Strasbourg, France IRCAD, Institute for Research against Cancer of the Digestive System, Strasbourg, France CHUV, University Hospital of Lausanne, Switzerland
IHU Institute for Minimally Invasive Image-Guided Surgery, Strasbourg, France.
Surg Innov. 2015 Feb;22(1):5-14. doi: 10.1177/1553350614552734. Epub 2014 Oct 7.
Selective embolization of the left-gastric artery (LGA) reduces levels of ghrelin and achieves significant short-term weight loss. However, embolization of the LGA would prevent the performance of bariatric procedures because the high-risk leakage area (gastroesophageal junction [GEJ]) would be devascularized.
To assess an alternative vascular approach to the modulation of ghrelin levels and generate a blood flow manipulation, consequently increasing the vascular supply to the GEJ.
A total of 6 pigs underwent a laparoscopic clipping of the left gastroepiploic artery. Preoperative and postoperative CT angiographies were performed. Ghrelin levels were assessed perioperatively and then once per week for 3 weeks. Reactive oxygen species (ROS; expressed as ROS/mg of dry weight [DW]), mitochondria respiratory rate, and capillary lactates were assessed before and 1 hour after clipping (T0 and T1) and after 3 weeks of survival (T2), on seromuscular biopsies. A celiac trunk angiography was performed at 3 weeks.
Mean (±standard deviation) ghrelin levels were significantly reduced 1 hour after clipping (1902 ± 307.8 pg/mL vs. 1084 ± 680.0; P = .04) and at 3 weeks (954.5 ± 473.2 pg/mL; P = .01). Mean ROS levels were statistically significantly decreased at the cardia at T2 when compared with T0 (0.018 ± 0.006 mg/DW vs. 0.02957 ± 0.0096 mg/DW; P = .01) and T1 (0.0376 ± 0.008 mg/DW; P = .007). Capillary lactates were significantly decreased after 3 weeks, and the mitochondria respiratory rate remained constant over time at the cardia and pylorus, showing significant regional differences.
Manipulation of the gastric flow targeting the gastroepiploic arcade induces ghrelin reduction. An endovascular approach is currently under evaluation.
选择性栓塞胃左动脉（LGA）可降低胃饥饿素水平并在短期内实现显著体重减轻。然而，LGA栓塞会妨碍减肥手术的实施，因为高风险渗漏区域（胃食管交界处[GEJ]）会出现血管缺失。
评估一种调节胃饥饿素水平的替代性血管途径，并进行血流调控，从而增加GEJ的血管供应。
总共6头猪接受了腹腔镜下胃网膜左动脉夹闭术。术前和术后均进行了CT血管造影。围手术期评估胃饥饿素水平，之后每周评估一次，持续3周。在夹闭前和夹闭后1小时（T0和T1）以及存活3周后（T2），对浆肌层活检组织进行活性氧（ROS；以ROS/毫克干重[DW]表示）、线粒体呼吸率和毛细血管乳酸水平的评估。在3周时进行了腹腔干血管造影。
夹闭后1小时（1902±307.8 pg/mL对1084±680.0；P = 0.04）和3周时（954.5±473.2 pg/mL；P = 0.01），平均（±标准差）胃饥饿素水平显著降低。与T0（0.018±0.006 mg/DW对0.02957±0.0096 mg/DW；P = 0.01）和T1（0.0376±0.008 mg/DW；P = 0.007）相比，T2时贲门处的平均ROS水平在统计学上显著降低。3周后毛细血管乳酸水平显著降低，贲门和幽门处的线粒体呼吸率随时间保持恒定，显示出显著的区域差异。
针对胃网膜弓进行胃血流调控可导致胃饥饿素减少。目前正在评估一种血管内途径。
