Linder Gustav, Hedberg Jakob, Björck Martin, Sundbom Magnus
Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
Dis Esophagus. 2017 Jan 1;30(1):143-149. doi: 10.1111/dote.12537.
In esophageal cancer surgery, perfusion of the gastric conduit is a critical issue. Measurement of gastric intramucosal pH (pHi) is a method to identify anaerobic metabolism as a sign of impaired perfusion. In this study we aimed to monitor changes in the perfusion of the gastric conduit at key steps during and after esophagectomy. pHi was measured per- and postoperatively using intermittent gastric tonometry in 32 patients undergoing open, 65%, or video-assisted thoracoscopic esophagectomy for esophageal cancer. Measurements focused on the surgical steps when the vascular supply to the gastric conduit was altered. A tonometry catheter was successfully placed in all patients and a decrease in pHi (mean ± SD) was observed from baseline to after the division of the short gastric vessels (7.33 ± 0.07 to 7.29 ± 0.07, P = 0.005). A further reduction after the ligation of the left gastric artery (7.26 ± 0.08, P < 0.001) and after final linear stapling the gastric conduit (7.15 ± 0.13, P < 0.001) was observed. Two hours after surgery, pHi increased (7.24 ± 0.09, P = 0.002). In contrast to open surgery, a trend towards less reduction in pHi was seen in thoracoscopic surgery. Patients with anastomotic leaks had lower pHi on the first postoperative day (7.12 ± 0.05 vs. 7.27 ± 0.08, P = 0.040). It can be concluded that each surgical step altering the vascular supply to the gastric conduit resulted in detectable changes, however transient, in pHi. Patients with low pHi on the first postoperative day were more prone to have clinically relevant anastomotic leaks.
在食管癌手术中，胃代食管管道的灌注是一个关键问题。测量胃黏膜内pH值（pHi）是一种识别无氧代谢的方法，无氧代谢是灌注受损的标志。在本研究中，我们旨在监测食管癌患者在食管切除术中及术后关键步骤时胃代食管管道灌注的变化。对32例行开放手术、65%或电视辅助胸腔镜食管癌切除术的患者，在术前和术后使用间歇性胃张力测定法测量pHi。测量重点是胃代食管管道血管供应改变时的手术步骤。所有患者均成功放置了张力测定导管，从基线到胃短血管离断后，观察到pHi（均值±标准差）下降（从7.33±0.07降至7.29±0.07，P = 0.005）。在结扎胃左动脉后（7.26±0.08，P < 0.001）以及最终用直线缝合器闭合胃代食管管道后（7.15±0.13，P < 0.001），pHi进一步降低。术后2小时，pHi升高（7.24±0.09，P = 0.002）。与开放手术相比，胸腔镜手术中pHi降低的趋势较小。吻合口漏的患者术后第一天的pHi较低（7.12±0.05对7.27±0.08，P = 0.040）。可以得出结论，改变胃代食管管道血管供应的每个手术步骤都会导致pHi出现可检测到的变化，尽管是短暂的。术后第一天pHi低的患者更易发生具有临床意义的吻合口漏。
