Realtime evaluation of the tracheal blood flow with use of laser doppler flowmeter during operation for the esoghageal cancer wit radical lymph nodes dissection

食管癌淋巴结清扫术中激光多普勒流量计实时评估气管血流

• 批准号: 06671242
• 负责人: KOIDE Yoshio
• 金额: $ 1.02万
• 依托单位: Chiba University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (C)
• 财政年份: 1994
• 资助国家: 日本
• 起止时间: 1994 至 1995
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-06671242/
• 关键词: esophageal cancer; radical lymph nodes dissecton of the upper mediastinum; tracheal blood flow; bronchial arteries; laser doppler flowmeter; preserve the blood supply; リンパ節徹底郭清; 気管・気管支

It is important to preserve the blood supply to the trachea during the operation for the esophageal cancer with radical lymph nodes dissecton of the upper mediastinum. In this study, the change of the tracheal blood flow (TBF) was measured with use of laser doppler flowmeter (LDF) during the operation. Materials and Methods ; The change of TBF of 21 patients was measured with LDF during the general surgery and that of three dogs was measured during the radical lymph nodes dissection of the upper mediastinum with ligature of the bronchial arteries. The sensor of the LDF was fixed to the endotracheal cuff and attached to the tracheal mucosa of the membranous wall. Results ; TBF which measured with LDF decreased when the tracheal cuff pressure rose and increased when it fell. LDF made rapid responce to the change of TBF.During the arteficial respiration, TBF increased by expiration and decreased by inspiration. TBF increased when blood pressure rose rapidly and decreased when it fell. TBF increased by raising of the legs and the arms, by using of pneumatic tourniquet and by the pneumoperitoneum. It decreased by static oppression of the trachea at the neck. During the dissection of the upper mediastinum of the dogs, TBF decreased after the ligature of the intercostobronchial arteries and the bronchial arteries arising from the aorta. After the resection of the tracheal proper seaths, TBF did not changed. Disscusion ; LDF could measure the rapid change of TBF and had the possibility to be useful as the anesthetic monitor system. We reported the anatomy of the bronchial arteries before this study and described that they course through the tracheal proper sheath to the trachea. The present study support it from the view of the blood flow, and preserving the bronchial arteries and the tracheal proper sheath is important during the upper medaistinum dissection.

在食管癌伴上纵隔淋巴结清扫的手术中，保证气管的血液供应是非常重要的。本研究采用激光多普勒血流仪（LDF）测量术中气管血流（TBF）的变化。材料与方法；21例患者在普通手术期间用LDF测量TBF的变化，3只狗在支气管动脉结扎的上纵隔根治性淋巴结清扫术中测量TBF的变化。LDF传感器固定在气管内袖套上，附着在气管膜壁粘膜上。结果;LDF测量的TBF随气管袖套压力升高而降低，随袖套压力降低而升高。LDF对TBF的变化反应迅速。在人工呼吸过程中，TBF随呼气而增加，随吸气而减少。血压快速升高时TBF增高，血压下降时TBF降低。抬高腿和手臂、使用气腹和气止带均可增加TBF。它通过颈部气管的静态压迫而减少。在狗的上纵隔剥离过程中，结扎肋间支气管动脉和源自主动脉的支气管动脉后，TBF下降。切除气管适当垫后，TBF无变化。讨论与;LDF可以测量TBF的快速变化，有可能作为麻醉监测系统。在本研究之前，我们报道了支气管动脉的解剖结构，并描述了它们穿过气管固有鞘到达气管。本研究从血流的角度支持了这一观点，在上纵膈夹层中保留支气管动脉和气管固有鞘是重要的。