Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Division of Next Generation Endoscopic Intervention, Global Center for Medical Engineering and Informatics, Osaka University, Suite 0912, Center of Medical Innovation and Translational Research, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Surg Endosc. 2018 Feb;32(2):1043-1050. doi: 10.1007/s00464-017-5914-1. Epub 2017 Oct 24.
Intestinal ischemia can lead to fatal complications if left unrecognized during surgery. The current techniques of intraoperative microvascular assessment remain subjective. Probe-based confocal laser endomicroscopy (pCLE) has the potential to objectively evaluate microvascular blood flow in real-time setting. The present study evaluated the technical feasibility of real-time intestinal bloodstream evaluation using pCLE in a porcine intestinal ischemia model.
Seven pigs were used. The intestinal ischemia model was prepared by sequentially dividing the mesenteric blood vessels. The intestinal bloodstream was evaluated on its serosal surface using pCLE (Cellvizio 488 probe, Ultra Mini O) at every 1-cm segment from a vessel-preservation border (i.e., the cut end of the vessel). Images of the blood vessels and flow of red blood cells (RBCs) in each visualized vessel were semi-qualitatively assessed using a 3-scale scoring system. In addition, 25 surgeons blindly assessed the 10 movies recorded at 0, 1, 2, 3, and 5 cm from a vessel-preservation border using a 4-scale scoring system to confirm the consistency of the evaluation of the pCLE system.
Images of the blood vessels were successfully obtained from the cut end of the vessel to the segment 4 cm away. Good unidirectional flow of RBCs was observed from the cut end to the 2-cm segment, whereas the flow became bidirectional between 2 and 3 cm segments. Beyond 4 cm, no flow images were obtained. The specimen obtained from the segment beyond 4 cm showed remarkable mucosal color change, which was confirmed as a necrotic change histologically. The evaluations from the cut end of the vessel to the segment 1 cm away by surgeons were excellent or good and it was almost consistent.
Real-time bloodstream evaluation using pCLE is feasible and potentially effective for predicting intestinal ischemia during surgery.
术中未识别肠缺血可导致致命并发症。目前的术中微血管评估技术仍然是主观的。基于探头的共聚焦激光内窥镜（pCLE）具有实时评估微血管血流的潜力。本研究评估了在猪肠缺血模型中使用 pCLE 实时肠血流评估的技术可行性。
本研究使用了 7 头猪。通过依次分离肠系膜血管来制备肠缺血模型。使用 pCLE（Cellvizio 488 探头，Ultra Mini O）在每个 1cm 节段的浆膜表面评估肠血流，从保留血管边界（即血管的切割端）开始。使用 3 级评分系统对每个可视化血管的血管图像和红细胞（RBC）的血流进行半定量评估。此外，25 名外科医生使用 4 级评分系统对记录的距离保留血管边界 0、1、2、3 和 5cm 的 10 个电影进行盲法评估，以确认 pCLE 系统评估的一致性。
从血管切割端到距离血管 4cm 的节段成功获得了血管图像。从切割端到 2cm 节段观察到良好的 RBC 单向流动，而在 2cm 到 3cm 节段之间流动变为双向。超过 4cm 时，未获得血流图像。距离 4cm 以外的节段获得的标本表现出明显的黏膜颜色变化，组织学上证实为坏死变化。外科医生对从血管切割端到距离 1cm 的节段的评估为优秀或良好，几乎一致。
使用 pCLE 进行实时血流评估对于预测手术期间的肠缺血是可行且有效的。
