Effects of Intraoperative Preservation of the Bronchial Artery and The Vagus Nerve on Pulmonary Complications after Surgery for Esophageal Cancer

We investigated the relationship between prevention of pulmonary complications after surgery for esophageal cancer and preservation of the right bronchial artery and the vagus nerve during surgery experimentally in dogs and clinically. Changes of the extravascular thermal lung water volume (EVTV) were studied using thermal-dye double-indicator dilution method, and changes in the bronchial mucosal blood flow (BMBF) using Laser Doppler Velocimetry. 1 Vagotomy significantly increased EVTV, which was marked in dogs with extensive mobilization of the trachea. 2 No change in EVTV was observed after the dissection of the right bronchial artery alone. 3 The EVTV increase is thought to be attributable to alteration of pulmonary permeability and elevated hydrostatic pressure. 4 When the bronchial artery was tentatively blocked, BMBF was immediately decreased by half, and immediately recovered to the presurgical value when the block was released. 5 BMBF in dogs with ablation around the trachea decreased to less than one fifth of the presurgical value immediately after the surgery, and tended to increas for 4 days after the surgery. However, it did not return to the presurgical level. 6 In patients with esophageal cancer, extended lymph node dissection resulted in signficant decrease in BMBF. It was assumed that saving the right bronchial artery and the pulmonary branches of the vaguse nerve during the mediastinal dissection in esophagectomy is useful for prevention of postoperative pulmonary complications.

胸部食道癌

術後肺合併症

肺内血管外水分量

器官粘膜血流量

上縦隔郭清