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首页> 外文期刊>Surgical Endoscopy >Experimental model of laparoscopic gastric ischemic preconditioning prior to transhiatal esophagectomy.
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Experimental model of laparoscopic gastric ischemic preconditioning prior to transhiatal esophagectomy.

机译：经腹腔镜食管切除术前腹腔镜胃缺血预处理的实验模型。

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BACKGROUND: Cervical esophagogastric anastomotic disruption following transhiatal esophagectomy (THE) is a significant problem. Gastric tip ischemia is a primary cause of anastomotic failure. We examined gastric tip blood flow when laparoscopic "ischemic preconditioning" was attempted by selectively ligating the short gastric (SG) vessels or both the left and short gastric (LG/SG) vessels prior to THE. METHODS: Seventeen (25 kg) mongrel dogs underwent laparoscopy followed 3 weeks later by THE. Three groups were studied: control group = laparoscopy only, no preconditioning (n = 6); SG group = laparoscopic ligation of SG vessels only (n = 5); and LG/SG group = laparoscopic ligation of LG and SG vessels (n = 6). Tissue blood flow was assessed using the fluorescent microsphere method. The initial microsphere injections occurred prior to pneumoperitoneum and upon completion of the laparoscopy. At the second operation, transhiatal esophagectomy was performed and microsphere blood flow assessment occurred after induction of anesthesia, after mobilization of the stomach, and after completion of the cervical esophagogastric anastomosis. The animals were euthanized and regional gastric tissue was analyzed for microsphere estimates of blood flow. Differences in blood flow were evaluated using Student's t test. RESULTS: The mean baseline gastric blood flow was 0.58 ml/min/g. After THE, the proximal gastric blood flow fell to 16% of baseline in control and 22% in SG, but was reduced to only 60% of baseline in LG/SG. This relative preservation of blood flow among the LG/SG group approached significance compared with the laparoscopy-only (control) group (P = 0.07). Ligation of SG vessels alone provided no preservation of proximal gastric blood flow following THE. CONCLUSION: Preoperative "ischemic preconditioning" through ligation of both the short and left gastric vessels may achieve preservation of blood flow to the gastric tip. Preconditioning during laparoscopic staging of esophageal carcinoma may be considered to reduce anastomotic complications following esophagectomy.
机译：背景：经食管食管切除术（THE）后的宫颈食管胃吻合破坏是一个重大问题。胃尖部缺血是吻合失败的主要原因。我们尝试通过选择性地结扎THE之前的胃短（SG）血管或左胃短（LG / SG）血管尝试腹腔镜“缺血预处理”时的胃尖血流。方法：对十七只（25公斤）杂种犬进行腹腔镜检查，然后在3周后进行THE。研究了三组：对照组=仅腹腔镜检查，无预处理（n = 6）; SG组=仅腹腔镜结扎SG血管（n = 5）; LG / SG组=腹腔镜结扎LG和SG血管（n = 6）。使用荧光微球法评估组织血流量。最初的微球注射发生在气腹之前和腹腔镜检查完成时。在第二次手术中，进行了经食管的食管切除术，并在麻醉诱导后，胃动员后和完成了颈食管胃吻合术后进行了微球血流评估。对动物实施安乐死并分析局部胃组织的血流微球估计。使用学生t检验评估血流差异。结果：平均基线胃血流量为0.58 ml / min / g。 THE后，胃近端血流在对照组中降至基线的16％，在SG中降至22％，但在LG / SG中降至基线的60％。与仅腹腔镜检查（对照组）组相比，LG / SG组之间的这种相对血流保存意义显着（P = 0.07）。仅SG血管的结扎不能在THE之后保留近端胃血流。结论：术前通过短和左胃血管结扎进行“缺血性预处理”可保持流向胃尖的血流。可以考虑在腹腔镜食管癌分期中进行预处理，以减少食管切除术后的吻合并发症。

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