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

在食管癌上纵隔淋巴结清扫术中，保留气管血供是非常重要的。本研究应用激光多普勒血流仪（LDF）监测了术中气管血流的变化。材料和方法;本文应用LDF法测定了21例病人在普外科手术中TBF的变化，并对3只狗在上纵隔淋巴结清扫术中结扎支气管动脉时TBF的变化进行了测定。LDF的传感器固定在气管内套囊上，并附着在膜壁的气管粘膜上。结果：LDF法测得的TBF随气管套囊压力的升高而降低，随压力的降低而升高。LDF对TBF的变化反应迅速，在动脉式呼吸过程中，TBF随呼气而增加，随吸气而减少。TBF随血压升高而增加，随血压下降而减少。抬高腿和手臂、使用充气止血带和气腹可增加TBF。颈部气管的静态压迫使其减少。在解剖犬上纵隔时，结扎肋间支气管动脉和支气管动脉后，TBF减少。切除气管固有支气管后，TBF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。我们在本研究之前报告了支气管动脉的解剖结构，并描述了它们通过气管固有鞘到达气管。本研究从血流的角度支持这一观点，认为在上纵隔解剖中，保留支气管动脉和气管固有鞘是重要的。

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.