Blood flow ratio in the gastric conduit measured by laser Doppler flowmetry: A predictor of anastomotic leakage after esophagectomy

IF 2.9 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of Gastroenterological Surgery Pub Date : 2023-11-20 DOI:10.1002/ags3.12754
Hirotaka Ishida, Toshiaki Fukutomi, Yusuke Taniyama, Chiaki Sato, Hiroshi Okamoto, Yohei Ozawa, Yu Onodera, Ken Koseki, Michiaki Unno, Takashi Kamei
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Abstract

Background

Anastomotic leakage after esophagectomy is a common complication. Laser Doppler flowmetry (LDF) can quantitatively evaluate the blood flow in the gastric conduit.

Methods

A total of 326 patients who underwent thoracoscopic/robot-assisted esophagectomy followed by gastric conduit reconstruction and end-to-side anastomosis were enrolled. We divided the gastric conduit into zones I (dominated by the right gastroepiploic vessels), II (dominated by the left gastroepiploic vessels), and III (perfused with short gastric vessels). Before pulling up the gastric conduit to the neck, LDF values were measured at the pylorus, the border between zones I and II (zone I/II), the border between zones II and III (zone II/III), and the gastric conduit tip (tip). The blood flow ratio was calculated as the LDF value divided by the LDF value at the pylorus.

Results

Anastomotic leakage developed in 32 of 326 patients. Leakage was significantly associated with the blood flow ratio at the tip (p < 0.001), but not at zone I/II, zone II/III, and the anastomotic site. The receiver-operating characteristic curve analysis identified an anastomotic leakage cutoff ratio of 0.41 (at the tip). A multivariate Cox analysis showed that a blood flow ratio <0.41 at the tip was an independent risk factor for anastomotic leakage (p < 0.001).

Conclusion

Anastomotic leakage after esophagectomy was significantly associated with the blood flow ratio at the tip of the gastric conduit. Preservation of the blood supply to the tip via the gastric wall might contribute to a decreased incidence of anastomotic leakage.

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通过激光多普勒血流测量仪测量胃导管中的血流比率:食管切除术后吻合口漏的预测指标
食管切除术后吻合口漏是一种常见的并发症。激光多普勒血流测量仪(LDF)可定量评估胃导管内的血流情况。我们共登记了326例接受胸腔镜/机器人辅助食管切除术后进行胃导管重建和端侧吻合术的患者。我们将胃导管分为 I 区(以右胃息肉血管为主)、II 区(以左胃息肉血管为主)和 III 区(以短胃血管灌注)。在将胃导管拉至颈部之前,在幽门、I 区和 II 区交界处(I/II 区)、II 区和 III 区交界处(II/III 区)以及胃导管顶端(顶端)测量 LDF 值。血流比率的计算方法是 LDF 值除以幽门处的 LDF 值。326 例患者中有 32 例出现吻合口渗漏。渗漏与顶端的血流比率有明显关系(p < 0.001),但与 I/II 区、II/III 区和吻合口部位无关。接受者操作特征曲线分析确定吻合口渗漏临界比率为 0.41(顶端)。多变量考克斯分析显示,顶端血流比小于 0.41 是吻合口漏的独立风险因素(p < 0.001)。食管切除术后吻合口漏与胃导管顶端血流比显著相关。食管切除术后吻合口漏与胃导管顶端的血流比率明显相关。通过胃壁保留对顶端的血液供应可能有助于降低吻合口漏的发生率。
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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
期刊最新文献
Laparoscopic median arcuate ligament release using an anterior approach for median arcuate ligament syndrome Issue Information Essential updates 2022-2023: Surgical and adjuvant therapies for locally advanced colorectal cancer. Phase II study of long-course chemoradiotherapy followed by consolidation chemotherapy as total neoadjuvant therapy in locally advanced rectal cancer in Japan: ENSEMBLE-2. Essential updates 2022/2023: Recent advances in perioperative management of esophagectomy to improve operative outcomes.
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