Delko Tarik, Hoffmann Henry, Kraljević Marko, Droeser Raoul A, Rothwell Lincoln, Oertli Daniel, Zingg Urs
Department of General and Visceral Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Department of Surgery, Ipswich General Hospital, Ipswich, QLD, Australia.
Obes Surg. 2017 Apr;27(4):926-932. doi: 10.1007/s11695-016-2386-7.
Laparoscopic sleeve gastrectomy (LSG) has become a very popular surgical treatment for the treatment of morbidly obese patients. Staple line leaks are the major cause of severe morbidity. Reasons for leaks might be hyperpressure (mechanical theory) or hypoperfusion (vascular theory) of the narrow gastric tube. This study assessed microperfusion patterns of the stomach during LSG using visible light spectroscopy (VLS), a method to measure tissue oxygenation (saturated O2 (StO2)).
The study population comprised 20 patients undergoing LSG. Real-time intraoperative microperfusion measurements were performed at nine different ventral stomach localizations in the antrum, body, and fundus at the beginning of the operation, after mobilization of the greater curve and after sleeve resection.
There were 17 women and 3 men, mean age 42.9 years, mean BMI 45.6 kg/m. There were no staple line leaks. StO2% values dropped substantially in the most cephalad area of measurement at the greater curve after mobilization (56 versus 49 %) and after resection (60 versus 49.5 %). The reduction in StO2 in the most cephalad area from before mobilization of the stomach to resection was 9.5 % (p < 0.01).
Assessment of microperfusion patterns of the stomach during LSG using VLS is safe and efficacious to use allowing an accurate measurement of StO2%. The upper third of the stomach is the zone of reduced microperfusion with a significant drop of tissue oxygenation after sleeve resection of the stomach.
腹腔镜袖状胃切除术（LSG）已成为治疗病态肥胖患者非常流行的手术方式。吻合口漏是严重并发症的主要原因。漏出的原因可能是狭窄胃管的高压（机械理论）或低灌注（血管理论）。本研究使用可见光光谱法（VLS）评估LSG术中胃的微灌注模式，VLS是一种测量组织氧合（饱和O2（StO2））的方法。
研究人群包括20例行LSG的患者。在手术开始时、大弯侧游离后和袖状胃切除后，在胃窦、胃体和胃底的九个不同前位胃部位进行实时术中微灌注测量。
有17名女性和3名男性，平均年龄42.9岁，平均BMI 45.6kg/m²。无吻合口漏。在大弯侧测量的最头侧区域，游离后（56%对49%）和切除后（60%对49.5%），StO2%值大幅下降。从胃游离前到切除后，最头侧区域的StO2降低了9.5%（p<0.01）。
使用VLS评估LSG术中胃的微灌注模式安全有效，可准确测量StO2%。胃的上三分之一是微灌注降低的区域，胃袖状切除后组织氧合显著下降。
