Ozawa Hiroyuki, Imanishi Yorihisa, Ito Fumihiro, Watanabe Yoshihiro, Kato Takashi, Nameki Hideo, Isobe Kiyoshi, Ogawa Kaoru
From the Department of Otolaryngology-Head and Neck Surgery (HO, FI, YW, KO), Keio University School of Medicine; Department of Otolaryngology, Head and Neck Surgery (YI), Kyorin University School of Medicine, Tokyo; Department of Otolaryngology, Head and Neck Surgery (TK, HN); Department of Surgery (KI), Shizuoka Red Cross Hospital, Shizuoka, Japan.
Medicine (Baltimore). 2015 Mar;94(11):e632. doi: 10.1097/MD.0000000000000632.
This study aimed to investigate the usefulness of intraluminal PCO2 (PiCO2) monitoring by air tonometry for the assessment of the vascular condition of the transferred jejunum after surgery for hypopharyngeal cancer.PiCO2 in the transplanted jejunum of 24 patients was monitored using air tonometry after radical surgery for hypopharyngeal cancer from 2003 to 2010.All but 1 patient, who removed the catheter before monitoring began, were monitored safely. PiCO2 in the transferred jejunum correlated with arterial PCO2 (PaCO2) that was measured concurrently, and dissociation of PiCO2 from PaCO2 was observed in cases with vascular complication. In those cases without postoperative vascular complication, the PiCO2 value gradually increased for 3 hours but then decreased by 12 hours after surgery. Three patients experienced major vascular complication. All 3 patients had continuous elevation of PiCO2 >100 mm Hg, although vascular flow in 1 patient recovered by removal of a venous thrombosis and reanastomosis of the vein 7.5 hours after surgery. Four other patients who experienced elevation of PiCO2 had their skin suture released for decompression of their neck wound, resulting in a decrease in PiCO2 after treatment.The current results demonstrated that continuous monitoring of PiCO2 by air tonometry accurately reflects the vascular condition of the transferred jejunum, and this method is one of the best options for postoperative monitoring of jejunum blood perfusion.
本研究旨在探讨通过空气眼压测量法进行腔内二氧化碳分压（PiCO2）监测，以评估下咽癌手术后移植空肠的血管状况。2003年至2010年，对24例下咽癌根治术后患者移植空肠的PiCO2进行了空气眼压测量法监测。除1例在监测开始前拔除导管的患者外，其余患者均安全完成监测。移植空肠的PiCO2与同时测量的动脉血二氧化碳分压（PaCO2）相关，在发生血管并发症的病例中观察到PiCO2与PaCO2的分离。在无术后血管并发症的病例中，PiCO2值在术后3小时逐渐升高，但在术后12小时下降。3例患者发生了严重血管并发症。所有3例患者的PiCO2持续升高>100 mmHg，尽管1例患者在术后7.5小时通过清除静脉血栓和静脉重新吻合，血管血流得以恢复。另外4例PiCO2升高的患者通过松开颈部伤口皮肤缝线进行减压治疗，治疗后PiCO2下降。目前的结果表明，通过空气眼压测量法持续监测PiCO2能准确反映移植空肠的血管状况，该方法是术后监测空肠血流灌注的最佳选择之一。
