Mingol-Navarro Fernando, Ballester-Pla Neus, Jimenez-Rosellon Raquel
Esophageal Surgery Unit, La Fe University Hospital, Valencia, Spain.
J Thorac Dis. 2019 Apr;11(Suppl 5):S663-S674. doi: 10.21037/jtd.2019.01.43.
A gastric conduit is most frequently used for reconstruction in oesophageal surgery, and ischemia of the conduit is the most fragile aspect of the esophagogastric anastomosis with as consequence the anastomotic leakage. In order to avoid it, the concept of ischaemic conditioning of the stomach previous to surgery has been designed. The basis of ischemic conditioning is that interrupting vascularization of the stomach before making the anastomosis eases the gastric fundus adaptation to ischemic conditions. It consists of the interruption of the principal feeding arteries of the stomach (except the right gastroepiploic artery) weeks before esophagectomy. Previously published literature contemplates two different techniques: angiographic embolization or laparoscopic ligation or division of vessels. In this study, the anatomic and physio-pathologic background of ischemic preconditioning is described and the published current evidence is reviewed.
胃代食管管道最常用于食管手术重建，管道缺血是食管胃吻合术中最脆弱的环节，其结果是吻合口漏。为避免这种情况，术前对胃进行缺血预处理的概念应运而生。缺血预处理的基础是在进行吻合之前中断胃的血管供应，从而使胃底更容易适应缺血状态。它包括在食管切除术数周前中断胃的主要供血动脉（右胃网膜动脉除外）。此前发表的文献提出了两种不同的技术：血管造影栓塞术或腹腔镜下血管结扎或离断术。本研究描述了缺血预处理的解剖学和生理病理学背景，并对已发表的现有证据进行了综述。
