Kusano C, Yamada H, Dougomori H, Natsugoe S, Baba M, Takao S, Fukumoto T, Aikou T
First Department of Surgery, Kagoshima University, School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Jun;44(6):795-800.
We measured serial changes in mucosal pH (pHi) as an index of blood flow of the stomach tube or the colon in a substitutive esophagus using a tonometer in 18 patients following surgery for esophageal cancer. The pHi showed the lowest level at the postoperative 1 hr (PO 1 hr) and increased significantly at PO 6 hr. At PO 12 hr, pHi showed the level of more than pHi 7.3 which increased significantly compared with PO 6 hr. The oxygen delivery and oxygen consumption increased significantly from PO 1 hr at PO 6 hr but not changed between 6 and 12 hr. It was suggested that the blood flow was inadequate in the stomach tube or the colon as a substitutive esophagus within PO 12 hr following operation despite of adequate oxygen delivery systemically. In this series, the decreased pHi were shown in 2 patients with minor leakage of anastomosis and in one patients with the perforation of stomach tube. The correlation between pHi and modified respiratory index was recognized at PO 12 hr and 24 hr suggesting that pHi was associated with the pulmonary dysfunction. Therefore, it was suggested that the value and change of pHi is an useful predicting index of occurrence of anastomotic leakage or respiratory failure which may be a fatal postoperative complication after surgery for esophageal cancer.
我们在18例食管癌手术后的患者中，使用张力计测量了代食管胃管或结肠黏膜pH值（pHi）的系列变化，以此作为其血流指标。pHi在术后1小时（PO 1小时）时处于最低水平，在PO 6小时时显著升高。在PO 12小时时，pHi显示超过7.3，与PO 6小时相比显著升高。氧输送和氧消耗从PO 1小时到PO 6小时显著增加，但在6至12小时之间没有变化。这表明尽管全身氧输送充足，但在术后12小时内代食管的胃管或结肠血流不足。在该系列中，2例吻合口轻度渗漏患者和1例胃管穿孔患者出现pHi降低。在PO 12小时和24小时时，pHi与改良呼吸指数之间存在相关性，提示pHi与肺功能障碍有关。因此，提示pHi的值及变化是吻合口漏或呼吸衰竭发生的有用预测指标，而吻合口漏或呼吸衰竭可能是食管癌手术后致命的术后并发症。
