术前血管造影及术中多普勒血流探测在结肠代食管术中的应用

The application of preoperative angiography and intraoperative Doppler blood flow detection in the surgery of colonic interposition for esophageal

目的 探讨术前血管造影及术中多普勒血流探测在结肠代食管术中的应用价值.方法 选择37例行结肠代食管术患者,行结肠代食管常规术式17例（常规组）;术前行肠系膜上、下动脉血管造影,术中行多普勒血管超声检测20例（改良组）,观察两组临床疗效.结果 常规组术后6～15d出现吻合口瘘4例,手术时间（367.0±53.3） min;改良组术后7d出现吻合口瘘1例,手术时间（302.0±67.1） min,两组手术时间比较差异有统计学意义（P＜0.05）.结论 结肠代食管术前血管造影及术中进行移植结肠段的多普勒血流探测,可实时直观地显示移植结肠段血管形态学表现,观察肠系膜血管的走行方向及分布范围,为移植结肠段血管提供准确可靠的评价,指导最佳移植结肠段的选择,在一定程度上降低了术后并发症的发生.

Objective To investigate the effect of preoperative angiography and intraoperative Doppler blood flow detection in the surgery of colonic interposition for esophageal. Methods Thirty-seven patients who underwent the surgery of colonic interposition for esophageal were chosen, 17 cases received colonic interposition for esophageal routine operation （routine group）, and 20 cases received preoperative angiography of superior and inferior mesenteric arteries and intraoperative Doppler blood flow detection （improved group）, the clinical efficacy was observed. Results Routine group occurred anastomotic leak in 4 cases on postoperative 6 - 15 d, operation time was （367.0 ± 53.3 ） min, and improved group occurred anastomotic leak in 1 case on postoperative 7 d, operation time was （302.0 ± 67.1 ） rain, the operation time between two groups had significant difference （P 〈 0.05 ）. Conclusions The adoption of preoperative angiography and intraoperative Doppler blood flow detection can real-time directly display the vascular morphology of transplanted colon segment, observe the traveling direction and distribution of mesenteric arteries, provide accurate and reliable evaluation of blood vessel of transplanted colon, which can conduct to the optimum selection of transplanted colon and reduce the incidence of postoperative complications.