Jansen S M, de Bruin D M, van Berge Henegouwen M I, Bloemen P R, Strackee S D, Veelo D P, van Leeuwen T G, Gisbertz S S
Departments of Biomedical Engineering and Physics.
Plastic, Reconstructive and Hand Surgery.
Dis Esophagus. 2018 Oct 1;31(10). doi: 10.1093/dote/doy031.
Compromised perfusion due to ligation of arteries and veins in esophagectomy with gastric tube reconstruction often (5-20%) results in necrosis and anastomotic leakage, which relate to high morbidity and mortality (3-4%). Ephedrine is used widely in anesthesia to treat intraoperative hypotension and may improve perfusion by the increase of cardiac output and mean arterial pressure (MAP). This study tests the effect of ephedrine on perfusion of the future anastomotic site of the gastric conduit, measured by laser speckle contrast imaging (LSCI). This prospective, observational, in vivo pilot study includes 26 patients undergoing esophagectomy with gastric tube reconstruction from October 2015 to June 2016 in the Academic Medical Center (Amsterdam). Perfusion of the gastric conduit was measured with LSCI directly after reconstruction and after an increase of MAP by ephedrine 5 mg. Perfusion was quantified in flux (laser speckle perfusion units, LSPU) in four perfusion locations, from good perfusion (base of the gastric tube) toward decreased perfusion (fundus). Intrapatient differences before and after ephedrine in terms flux were statistically tested for significance with a paired t-test. LSCI was feasible to image gastric microcirculation in all patients. Flux (LSPU) was significantly higher in the base of the gastric tube (791 ± 442) compared to the fundus (328 ± 187) (P < 0.001). After administration of ephedrine, flux increased significantly in the fundus (P < 0.05) measured intrapatients. Three patients developed anastomotic leakage. In these patients, the difference between measured flux in the fundus compared to the base of the gastric tube was high. This study presents the effect of ephedrine on perfusion of the gastric tissue measured with LSCI in terms of flux (LSPU) after esophagectomy with gastric tube reconstruction. We show a small but significant difference between flux measured before and after administration of ephedrine in the future anastomotic tissue (313 ± 178 vs. 397 ± 290). We also show a significant decrease of flux toward the fundus.
在采用胃管重建的食管癌切除术中，动脉和静脉结扎导致的灌注受损常常（5%-20%）会引发坏死和吻合口漏，这与高发病率和死亡率（3%-4%）相关。麻黄碱在麻醉中广泛用于治疗术中低血压，并且可能通过增加心输出量和平均动脉压（MAP）来改善灌注。本研究通过激光散斑对比成像（LSCI）测试麻黄碱对胃导管未来吻合部位灌注的影响。这项前瞻性、观察性的体内初步研究纳入了2015年10月至2016年6月在学术医疗中心（阿姆斯特丹）接受胃管重建食管癌切除术的26例患者。在重建后以及给予5毫克麻黄碱使MAP升高后，立即用LSCI测量胃导管的灌注。在四个灌注部位从灌注良好（胃管底部）到灌注降低（胃底）以通量（激光散斑灌注单位，LSPU）对灌注进行量化。使用配对t检验对患者体内麻黄碱给药前后通量方面的差异进行统计学显著性检验。LSCI对所有患者的胃微循环进行成像都是可行的。与胃底（328±187）相比，胃管底部的通量（LSPU）显著更高（791±442）（P<0.001）。在患者体内测量发现，给予麻黄碱后，胃底的通量显著增加（P<0.05）。3例患者发生吻合口漏。在这些患者中，胃底与胃管底部测量的通量差异很大。本研究呈现了在采用胃管重建的食管癌切除术后，麻黄碱对用LSCI测量的胃组织灌注通量（LSPU）的影响。我们显示，在未来吻合组织中，给予麻黄碱前后测量的通量存在微小但显著的差异（313±178与397±290）。我们还显示向胃底的通量显著降低。
