Jacobi C A, Zieren H U, Zieren J, Müller J M
Department of Surgery, University Hospital Charité, Humboldt University Berlin, Germany.
J Surg Res. 1998 Feb 1;74(2):161-4. doi: 10.1006/jsre.1997.5239.
The genesis of anastomotic leakage and late stenosis of esophagogastrostomy is still unknown, although minimal blood flow and tissue hypoxia of the gastric tube are discussed as main reasons. However, the changes in tissue oxygen tension (PtO2) on esophagogastric anastomoses have not yet been evaluated in the perioperative course.
Submucosal tissue oxygen tension (PtO2) was measured in 33 patients with cervical esophagogastrostomy during resection of esophageal carcinoma and reconstruction by a gastric tube. Measurements were taken close to the projected resection line and latter anastomosis using a Clark-type oxygen electrode.
Mean baseline PtO2 was 55.1 +/- 10.4 mmHg. Following the ligature of the vasa gastricae brevis and the left gastroepiploic artery (46.1 +/- 9.7 mmHg), the left gastric artery (34.8 +/- 9.8 mmHg), and the pull up of the gastric tube, PtO2 decreased to 25.8 +/- 9.4 mmHg. Anastomotic leakage occurred in 6 patients and late stenosis in 10 patients. During the operation there was no significant evidence of decreased PtO2 levels in these two groups. Postoperative PtO2 levels showed a significant increase in patients with anastomotic leakage.
A disorder in oxygen consumption may cause a significant increase of PtO2 in anastomotic tissue, which is associated with anastomotic leakage.
尽管胃管血流量减少和组织缺氧被认为是食管胃吻合口漏及晚期狭窄的主要原因，但其发病机制仍不清楚。然而，围手术期食管胃吻合口处的组织氧分压（PtO2）变化尚未得到评估。
在33例行食管癌切除及胃管重建的颈段食管胃吻合术患者中，使用Clark型氧电极在预计切除线及吻合口附近测量黏膜下组织氧分压（PtO2）。
平均基础PtO2为55.1±10.4 mmHg。在结扎胃短血管和胃网膜左动脉后（46.1±9.7 mmHg），再结扎胃左动脉（34.8±9.8 mmHg）并上提胃管后，PtO2降至25.8±9.4 mmHg。6例患者发生吻合口漏，10例患者发生晚期狭窄。手术过程中，这两组患者的PtO2水平均无明显下降。吻合口漏患者术后PtO2水平显著升高。
氧消耗紊乱可能导致吻合口组织PtO2显著升高，这与吻合口漏有关。
