Influence of the bronchial artery and the vagus nerve on hemodynamic and respiratory changes following extended radical lymphadenectomy with esophagectomy.

支气管动脉和迷走神经对食管癌扩大根治性淋巴结切除术后血流动力学和呼吸变化的影响。

• 批准号: 02670617
• 负责人: FUJITA Hiromasa
• 金额: $ 1.41万
• 依托单位: Kurume 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: 1990
• 资助国家: 日本
• 起止时间: 1990 至 1991
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-02670617/
• 关键词: Extended radical lymphadenectomy; cardio-pulmonary function; postoperative pulmonary complication; Esophageal cancer operation; The bronchial artery; pulmonary branches of the vagus nerve; tracheal ischemia; pulmonary edema; 肺うっ血; 換気; 血流分布; vas

Extended radical lymphadenectomy has severe influence on the cardio-pulmonary function after esophagectomy, and frequently causes postoperative pulmonary complications. We have experimentally and clinically evaluated the efficacy of the preservation of the right bronchial artery and pulmonary branches of the right vagus nerve to prevent such complications.1. Preservation of the right bronchial artery prevented tracheal ischemia following cervical and upper mediastinal lymph node dissection in which the trachea had been isolated and devascularized.2. Preservation of the pulmonary branches of the right vagus nerve minimized pulmonary edema caused by cardiac failure following extended radical lymphadenectomy with esophagectomy. Pulmonary edema causes microatelectasis in the lung and increases the pulmonary shunt which is the most important factor leading to respiratory failure following esophagectomy.3. Preservation of the right bronchial artery and pulmonary branches of the right vagus nerve decreased the mortality rate after extended radical lymphadenectomy with esophagectomy for patients with an esophageal carcinoma, mainly due to such preservation minimizing cardiac and/or respiratory failure and preventing tracheal ischemia.

扩大根治性淋巴结清扫术严重影响食管癌术后心肺功能，易引起术后肺部并发症。我们通过实验和临床评估了保留右支气管动脉和右迷走神经肺支对预防此类并发症的有效性。结论：1.保留右支气管动脉可预防颈上纵隔淋巴结清扫术后气管缺血，其中气管已被分离和断流.保留右迷走神经的肺支可以最大限度地减少食管癌根治性淋巴结切除术后心力衰竭引起的肺水肿。肺水肿引起肺微肺不张，增加肺分流，是食管切除术后呼吸衰竭的重要原因.保留右支气管动脉和右迷走神经的肺支可降低食管癌患者行扩大根治性淋巴结切除术和食管切除术后的死亡率，主要是由于保留右支气管动脉和右迷走神经可最大限度地减少心脏和/或呼吸衰竭并防止气管缺血。

项目成果

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岛一郎：“胸段食管癌根治术中保留支气管动脉和迷走神经肺支的意义——术后急性期呼吸和血流动力学变化的实验研究”日本胸外科学会杂志 37. 2305。 - 2317 (1989)

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