Kam D M, Scheeres D E
Department of Surgery, Michigan State University/Butterworth Hospital, Grand Rapids 49503.
Surg Endosc. 1993 Mar-Apr;7(2):75-8. doi: 10.1007/BF00704381.
Accurate identification of acute mesenteric ischemia remains a challenge. It was hypothesized that fluorescein-assisted laparoscopy (FAL) may have a role in the identification of acute arterial mesenteric ischemia. Arterial ischemic small-bowel segments were prepared in 11 dogs. Following 2.5 h of ischemia, laparoscopy was performed with a standard light source followed by FAL with an argon laser. These two techniques were immediately compared with open inspection. Standard laparoscopy correctly identified 10 ischemic segments. FAL correctly identified 9 ischemic segments and the combination of the 2 techniques allowed laparoscopy to correctly identify all 11 ischemic segments. Standard laparotomy with and without fluorescein correctly identified 10 ischemic segments. The difference between laparoscopy and laparotomy was not significant (P > 0.6, Fisher's exact test). The combination of laparoscopic evaluation with and without fluorescein allowed identification of small-bowel ischemia in all subjects in this canine model. Further studies are warranted to delineate the accuracy of laparoscopy in other patterns of mesenteric insufficiency before clinical application.
准确识别急性肠系膜缺血仍然是一项挑战。据推测，荧光素辅助腹腔镜检查（FAL）可能在识别急性动脉性肠系膜缺血中发挥作用。在11只犬中制备了动脉缺血性小肠段。缺血2.5小时后，先用标准光源进行腹腔镜检查，然后用氩激光进行FAL。立即将这两种技术与开放检查进行比较。标准腹腔镜检查正确识别出10个缺血段。FAL正确识别出9个缺血段，两种技术联合使用使腹腔镜检查能够正确识别所有11个缺血段。使用和不使用荧光素的标准剖腹术均正确识别出10个缺血段。腹腔镜检查和剖腹术之间的差异不显著（P>0.6，Fisher精确检验）。在这个犬模型中，腹腔镜评估联合和不联合荧光素能够识别所有受试对象的小肠缺血。在临床应用之前，有必要进行进一步研究以确定腹腔镜检查在其他肠系膜功能不全模式中的准确性。
