The European journal of surgery = Acta chirurgica · 1994
Impaired healing of cervical oesophagogastrostomies can be predicted by estimation of gastric serosal blood perfusion by laser Doppler flowmetry.
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Pierie J P, De Graaf P W, Poen H, Van der Tweel I, Obertop H
Аннотация
OBJECTIVE: To assess the value of relative blood perfusion of the gastric tube in prediction of impaired healing of cervical oesophagogastrostomies.
DESIGN: Prospective study.
SETTING: University hospital, The Netherlands.
SUBJECTS: Thirty patients undergoing transhiatal oesophagectomy and partial gastrectomy for cancer of the oesophagus or oesophagogastric junction, with gastric tube reconstruction and cervical oesophagogastrostomy.
MAIN OUTCOME MEASURES: Operative measurement of gastric blood perfusion at four sites by laser Doppler flowmetry and perfusion of the same sites after construction of the gastric tube expressed as a percentage of preconstruction values.
RESULTS: The relative perfusion at the most proximal site of the gastric tube was significantly lower than at the more distal sites (p = 0.001). Nine of 18 patients (50%) in whom the perfusion of the proximal gastric tube was less than 70% of preconstruction values developed an anastomotic stricture, compared with only 1 of 12 patients (8%) with a relative perfusion of 70% or more (p = 0.024). A reduction in perfusion of the gastric tube did not predict leakage.
CONCLUSION: Impaired anastomotic healing is unlikely if relative perfusion is 70% or more of preconstruction values. Perfusion of less than 70% partly predicts the occurrence of anastomotic stricture, but leakage cannot be predicted. Factors other than blood perfusion may have a role in the process of anastomotic healing.
DESIGN: Prospective study.
SETTING: University hospital, The Netherlands.
SUBJECTS: Thirty patients undergoing transhiatal oesophagectomy and partial gastrectomy for cancer of the oesophagus or oesophagogastric junction, with gastric tube reconstruction and cervical oesophagogastrostomy.
MAIN OUTCOME MEASURES: Operative measurement of gastric blood perfusion at four sites by laser Doppler flowmetry and perfusion of the same sites after construction of the gastric tube expressed as a percentage of preconstruction values.
RESULTS: The relative perfusion at the most proximal site of the gastric tube was significantly lower than at the more distal sites (p = 0.001). Nine of 18 patients (50%) in whom the perfusion of the proximal gastric tube was less than 70% of preconstruction values developed an anastomotic stricture, compared with only 1 of 12 patients (8%) with a relative perfusion of 70% or more (p = 0.024). A reduction in perfusion of the gastric tube did not predict leakage.
CONCLUSION: Impaired anastomotic healing is unlikely if relative perfusion is 70% or more of preconstruction values. Perfusion of less than 70% partly predicts the occurrence of anastomotic stricture, but leakage cannot be predicted. Factors other than blood perfusion may have a role in the process of anastomotic healing.