Abstract
Introduction. The development of an objective non-invasive method for intraoperative assessment of intestinal viability remains urgent for modern surgery. In this context, the method of laser fluorescence spectroscopy (LFS) of coenzymes of oxidative metabolism, as well as a combination of this technique with the simultaneous use of laser Doppler flowmetry (LDF) seems promising. Materials and methods. The model of ischemia-reperfusion of the small intestine of 4 Californian Rabbits was used to study the relationship of the parameters of LFS and LDF with the histological picture. A model of intraoperative ischemia was used by temporarily clamping the trunk of the cranial mesenteric vascular bundle for 90 min, followed by intraoperative and postoperative reperfusion for 60 minutes and 24 hours, respectively. LDF and LFS data were recorded from intestine at the end of the intraoperative reperfusion period. 24 hours after the surgery, the animals were subjected to histologic evaluation of intestine ischemic changes, which were compared with the LDF and LFS data. Diagnostic value of LDF and LFS, and their combination for intraoperative assessment of intestinal viability were analyzed. Results. A significant correlation was found between the parameters of LDF, LFS and the degree of ischemic changes according to the histological data. The method of isolated assessment of the difference in the fluorescence of reduced nicotin adenine dinucleotide (NADH) before and after ischemia-reperfusion (77.3 %) has the greatest diagnostic value. The method has the highest sensitivity with a combination of differences in LDF and LFS values before and after ischemia-reperfusion (85.7 %) (P<0.05). Conclusions. LFS, as well as its combination with LDF, is a useful method for objective assessment of intestinal viability, which requires further research and has potential for clinical use.
Highlights
The model of ischemia-reperfusion of the small intestine of 4 Californian Rabbits was used to study the relationship of the parameters of laser fluorescence spectroscopy (LFS) and laser Doppler flowmetry (LDF) with the histological picture
A model of intraoperative ischemia was used by temporarily clamping the trunk of the cranial mesenteric vascular bundle for 90 min, followed by intraoperative and postoperative reperfusion for 60 minutes and 24 hours, respectively
LDF and LFS data were recorded from intestine at the end of the intraoperative reperfusion period. 24 hours after the surgery, the animals were subjected to histologic evaluation of intestine ischemic changes, which were compared with the LDF and LFS data
Summary
методами лазерной допплеровской флоуметрии и лазерной флуоресцентной спектроскопии. Статья поступила в редакцию 17.11.20 г.; принята к печати 05.02.21 г. Проведен анализ репрезентативности и равномерности значений показателей ЛДФ и НАДНфлуоресценции, зафиксированных до ишемии исследуемого терминального отдела подвздошной кишки. Проведен сравнительный анализ зафиксированных значений показателей ЛДФ и НАДН-флуоресценции на 60-й минуте реперфузии с результатами гистологического исследования кишечной стенки с определением их корреляции. Также проведен сравнительный анализ разниц значений показателей ЛДФ и НАДН-флуоресценции до и после ишемии-реперфузии с результатами гистологического исследования с определением их корреляции. Проведен анализ комбинированной оценки жизнеспособности кишечной стенки по одновременному учету показателей ЛДФ и НАДН-флуоресценции в определенном участке кишки. Результаты исследования и их обсуждение Средние значения показателя микроциркуляции и амплитуды флуоресценции кофермента окислительного метаболизма НАДН по данным ЛДФ и ЛФС в 44 измерениях до ограничения мезентериального кровотока составили: Мпм=29,1 п. Чувствительность, специфичность и точность регистрации некроза (патогистологических изменений 4–5-й степени) в стенке кишки после эпизода ишемии-реперфузии составили для ЛДФ 78,3, 65,1, 69,7 %; для НАДН-флуоресценции – 78,3, 62,8, 68,2 %. Полученные патогистологические изменения в стенке кишки в зависимости от удаленности от эпицентра ишемии
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