Türkyilmaz Z, Sönmez K, Başaklar A C, Demiroğullari B, Numanoğlu V, Ekingen G, Dursun A, Altin M A, Kale N
Pediatric Surgery Department, Gazi University School of Medicine, Ankara, Turkey.
J Pediatr Surg. 1997 Dec;32(12):1728-31. doi: 10.1016/s0022-3468(97)90517-0.
BACKGROUND/PURPOSE: Pulse oximetry has been proposed as an appropriate and feasible technique in the assessment of intestinal ischemia in recent years. In this study the authors aimed to assess the reliability of anastomoses in the dog small intestine in which there is graded irreversible ischemia as measured by pulse oxymeter.
In a control group of four dogs, without any devascularization, three small bowel anastomoses were formed in each dog. The study group consisted of 12 dogs. In each animal three intestinal segments with different levels of ischemia were created by ligating the marginal vessels proximally and distally in sequence beginning from the midpoint of the segmental vascular arcade. Preanastomotic pulse oximeter readings between 80% and 90% were assigned to mild ischemia, 70% and 80% to moderate, and 60% and 70% to severe ischemia group. Pulse oximetry measurements were obtained from probes applied to the antimesenteric serosal surfaces at the midpoint of small intestinal segments. A total of 48 intestinal segments (12 nonischemic in the control group and 36 with three different levels of ischemia in the study group) were transected in the midpoint and anastomosed in double layers. Postanastomotic SaO2 values were also noted. The anastomoses were evaluated 48 hours later macroscopically if there was any leakage, and biopsy specimens were obtained for histopathologic ischemic gradings. All results were studied statistically.
Histopathologic grades between each group were statistically different (P < .01 for each comparison) except for control and mild ischemia groups (P > .05), worsening as the level of ischemia increased. Pre- and postanastomotic pulse oximetry measurements correlated very well with the histological gradings (r = -0.90, P < .001 and r = -0.93, P < 0.001 respectively). Number of anastomotic leakages were none in control, one in mild, nine in moderate, and 12 (all of the anastomoses) in severe ischemia groups. In the moderate ischemia group with an average preanastomotic pulse reading of 76.75%, each of the leaking anastomoses had a postanastomotic pulse measurement of lower than 70%. The finding that the difference between histopathologic grades of control and mild ischemia groups with average preanastomotic pulse measurements of 96% and 85%, respectively is not statistically significant enables us to suggest that a saturation of at least 85% is necessary for a reliable anastomosis.
These results suggest clearly that anastomotic reliability can be predicted objectively with pulse oximetry.
背景/目的：近年来，脉搏血氧饱和度测定法已被提议作为评估肠缺血的一种合适且可行的技术。在本研究中，作者旨在评估通过脉搏血氧仪测量的犬小肠中存在分级不可逆缺血时吻合口的可靠性。
在一个由4只狗组成的对照组中，在没有任何血管离断的情况下，每只狗形成3个小肠吻合口。研究组由12只狗组成。在每只动物中，从节段性血管弓的中点开始，依次在近端和远端结扎边缘血管，创建3个不同缺血程度的肠段。吻合术前脉搏血氧仪读数在80%至90%之间被归为轻度缺血，70%至80%为中度缺血，60%至70%为重度缺血组。脉搏血氧饱和度测量是通过将探头应用于小肠段中点的系膜对侧浆膜表面获得的。总共48个肠段（对照组12个非缺血肠段，研究组36个具有三种不同缺血程度的肠段）在中点横断并进行双层吻合。同时记录吻合术后的血氧饱和度（SaO2）值。48小时后，宏观评估吻合口是否有渗漏，并获取活检标本进行组织病理学缺血分级。所有结果进行统计学研究。
除对照组和轻度缺血组之间差异无统计学意义（P > 0.05）外，各组之间的组织病理学分级差异有统计学意义（每次比较P < 0.01），随着缺血程度的增加而恶化。吻合术前和术后的脉搏血氧饱和度测量与组织学分级相关性非常好（分别为r = -0.90，P < 0.001和r = -0.93，P < 0.001）。对照组无吻合口渗漏，轻度缺血组有1例，中度缺血组有9例，重度缺血组有12例（所有吻合口）。在平均吻合术前脉搏读数为76.75%的中度缺血组中，每个渗漏的吻合口术后脉搏测量值均低于70%。对照组和轻度缺血组的组织病理学分级差异无统计学意义，其平均吻合术前脉搏测量值分别为96%和85%，这一发现使我们认为，可靠的吻合术至少需要85%的饱和度。
这些结果清楚地表明，脉搏血氧饱和度测定法可以客观地预测吻合口的可靠性。
