Urschel J D
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263-0001, USA.
Dis Esophagus. 1997 Jul;10(3):217-9. doi: 10.1093/dote/10.3.217.
Esophagogastric anastomotic leaks are a major cause of morbidity and mortality after esophagectomy. Occult ischemia of the mobilized and partially devascularized gastric fundus is an important cause of esophagogastric leaks. The author hypothesizes that the vascularity of the gastric fundus can be improved, and anastomotic leaks reduced, by a process of ischemic conditioning (delay phenomenon). Laparoscopic partial gastric devascularization could be performed 2-3 weeks before esophagectomy. The gastric fundus would have time to re-establish an abundant blood supply before being mobilized and anastomosed to the esophagus. Since laparoscopic partial devascularization could be done at the time of laparoscopic cancer staging, gastric ischemic conditioning would not necessarily add cost or morbidity to the overall treatment of esophageal cancer. Laboratory and clinical evidence are presented to support this hypothesis.
食管胃吻合口漏是食管切除术后发病和死亡的主要原因。游离且部分血运阻断的胃底隐匿性缺血是食管胃吻合口漏的重要原因。作者推测，通过缺血预处理（延迟现象）可改善胃底血运，减少吻合口漏。可在食管切除术前2 - 3周进行腹腔镜下部分胃去血管化。胃底在被游离并与食管吻合之前有时间重新建立丰富的血供。由于腹腔镜下部分去血管化可在腹腔镜癌症分期时进行，胃缺血预处理不一定会增加食管癌整体治疗的成本或发病率。本文提供了实验室和临床证据来支持这一假设。
