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

食道癌根治性上纵隔淋巴结清扫术中应注意保留气管的血供。本研究应用激光多普勒血流仪(LDF)测量了手术中气管血流量的变化。材料和方法：21例患者在普通外科手术中应用激光多普勒血流分析仪测量了TBF的变化，3只犬在结扎支气管动脉的上纵隔根治性淋巴清扫术中测量了TBF的变化。LDF传感器固定在气管袖套上，附着在气管膜壁的粘膜上。结果：LDF测得的TBF随气管袖套压力升高而减小，随气管袖带压力降低而增大。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，随吸气而降低。当血压迅速升高时，TBF升高，当血压下降时，TBF下降。抬高腿部和手臂、使用气压止血带和气腹可增加TBF。通过对颈部气管的静态压迫而减少。在犬上纵隔解剖过程中，结扎肋间支气管动脉和发自主动脉的支气管动脉后，TBF下降。切除气管固有口后，全血流量无明显变化。[结论]LDF能快速测量TBF的变化，有可能作为麻醉监测系统使用。在这项研究之前，我们报告了支气管动脉的解剖，并描述了它们通过气管固有鞘到达气管。本研究从血流角度支持这一观点，在上胸段解剖中保留支气管动脉和气管固有鞘是很重要的。

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.