Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering & Physics, Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering & Physics, Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Department of Urology, Amsterdam, The Netherlands.
Eur J Surg Oncol. 2021 May;47(5):1034-1041. doi: 10.1016/j.ejso.2020.09.006. Epub 2020 Sep 13.
Anastomotic leakage is one of the most severe complications in patients undergoing esophagectomy with gastric tube reconstruction. Transection of the left gastric and gastro-epiploic artery and vein results in compromised perfusion which is seen as the major contributing factor for anastomotic dehiscence. The main objective of this prospective, observational, in-vivo pilot study is to microscopically evaluate gastric tube perfusion with Sidestream Darkfield Microscopy (SDF).
Intra-operative microscopic images of gastric-microcirculation were obtained with SDF directly after reconstruction in 22 patients. Quantitative perfusion related parameters were: velocity, Microvascular Flow Index(MFI), Total Vessel Density(TVD), Perfusion Vessel Density(PVD), Proportion of Perfused Vessels(PPV) and De Backer Score(DBS). Dedicated software was used to assess parameters predictive for compromised perfusion.
SDF was feasible to accurately visualize and evaluate microcirculation in all patients. Velocity(μm/sec) was significantly decreased towards the fundus (p = 0.001). MFI, PVD and PVD were decreased distal of the watershed - between the right and left gastro-epiploic artery and vein - and in the fundus, compared to the base of the gastric tube(p = 0.0002). No differences in TVD and DBS were observed; because of vessel-dilation in the fundus-area. This suggests that venous congestion results in comprised inflow of oxygen rich blood and plays a role in the development of ischaemia.
We present quantitative perfusion imaging with SDF of the gastric tube. Velocity, MFI, TVD and PPV are accurate parameters to observe perfusion decrease. Also, venous congestion is visible in the fundus, suggesting an important role in the development of ischaemia. These parameters could allow early risk stratification, and, potentially, can accomplish a reduction in anastomotic leakage.
吻合口漏是胃管重建食管切除术患者最严重的并发症之一。切断胃左动脉和胃网膜左动脉和静脉会导致灌注受损，这被认为是吻合口裂开的主要因素。这项前瞻性、观察性、体内试验研究的主要目的是使用边流暗场显微镜（SDF）微观评估胃管灌注。
22 例患者在重建后直接用 SDF 获得胃微循环的术中显微镜图像。定量灌注相关参数为：速度、微血管血流指数（MFI）、总血管密度（TVD）、灌注血管密度（PVD）、灌注血管比例（PPV）和德贝克评分（DBS）。专用软件用于评估预测灌注受损的参数。
SDF 能够准确地可视化和评估所有患者的微循环。速度（μm/sec）向胃底方向明显降低（p=0.001）。MFI、PVD 和 PVD 在分水岭（胃网膜左动脉和静脉之间）和胃底较胃管基底降低，与胃底相比，PVD 和 PVD 降低（p=0.0002）。TVD 和 DBS 无差异；因为在胃底区域血管扩张。这表明静脉充血导致富含氧气的血液流入不足，并在缺血的发展中起作用。
我们提出了 SDF 对胃管的定量灌注成像。速度、MFI、TVD 和 PPV 是观察灌注减少的准确参数。此外，在胃底可以看到静脉充血，这表明在缺血的发展中起着重要作用。这些参数可以早期进行风险分层，并有可能减少吻合口漏。
