Pierie J P, De Graaf P W, Poen H, Van der Tweel I, Obertop H
Department of Surgery, University Hospital Utrecht, The Netherlands.
Eur J Surg. 1994 Nov;160(11):599-603.
To assess the value of relative blood perfusion of the gastric tube in prediction of impaired healing of cervical oesophagogastrostomies.
Prospective study.
University hospital, The Netherlands.
Thirty patients undergoing transhiatal oesophagectomy and partial gastrectomy for cancer of the oesophagus or oesophagogastric junction, with gastric tube reconstruction and cervical oesophagogastrostomy.
Operative measurement of gastric blood perfusion at four sites by laser Doppler flowmetry and perfusion of the same sites after construction of the gastric tube expressed as a percentage of preconstruction values.
The relative perfusion at the most proximal site of the gastric tube was significantly lower than at the more distal sites (p = 0.001). Nine of 18 patients (50%) in whom the perfusion of the proximal gastric tube was less than 70% of preconstruction values developed an anastomotic stricture, compared with only 1 of 12 patients (8%) with a relative perfusion of 70% or more (p = 0.024). A reduction in perfusion of the gastric tube did not predict leakage.
Impaired anastomotic healing is unlikely if relative perfusion is 70% or more of preconstruction values. Perfusion of less than 70% partly predicts the occurrence of anastomotic stricture, but leakage cannot be predicted. Factors other than blood perfusion may have a role in the process of anastomotic healing.
评估胃管相对血流灌注在预测颈段食管胃吻合口愈合不良中的价值。
前瞻性研究。
荷兰大学医院。
30例因食管癌或食管胃交界癌接受经裂孔食管切除术和部分胃切除术的患者，行胃管重建和颈段食管胃吻合术。
通过激光多普勒血流仪在四个部位对胃血流灌注进行手术测量，并将胃管构建后相同部位的灌注表示为构建前值的百分比。
胃管最近端部位的相对灌注显著低于更远端部位（p = 0.001）。18例近端胃管灌注低于构建前值70%的患者中有9例（50%）发生吻合口狭窄，而相对灌注为70%或更高的12例患者中只有1例（8%）发生吻合口狭窄（p = 0.024）。胃管灌注减少不能预测吻合口漏。
如果相对灌注为构建前值的70%或更高，则吻合口愈合不良的可能性不大。灌注低于70%可部分预测吻合口狭窄的发生，但无法预测吻合口漏。除血流灌注外的其他因素可能在吻合口愈合过程中起作用。
