WO2015193306A1

WO2015193306A1 - Medical measuring device for determining tissue blood perfusion

Info

Publication number: WO2015193306A1
Application number: PCT/EP2015/063466
Authority: WO
Inventors: Franz IMMLER
Original assignee: Immler Franz
Priority date: 2014-06-16
Filing date: 2015-06-16
Publication date: 2015-12-23

Abstract

The invention relates to a measuring device (100) for determining tissue blood perfusion, comprising at least two light-emitting devices (1) and at least two photosensors (3), the light-emitting devices (1) and the photosensors (3) being arranged in such a way that tissue blood perfusion can be measured in at least two points of a tissue at the same time by means of the measuring device (100).

Description

Besehreibung

Medical measuring device for determining the

Tissue perfusion

The present invention relates to a medical

Measuring device according to claim 1.

From medical practice are measuring devices for

Assessment of tissue perfusion known. They are as

Pulse oxymeter known, which are placed on the finger end member for measuring the patient.

The object of the invention is to provide another

Propose measuring device of tissue perfusion.

The object of the invention can be achieved by a measuring device having the features of claim 1. According to the invention, the medical measuring device (hereinafter referred to briefly: measuring device) for determining the

Tissue perfusion at least two light-emitting

Facilities and at least two photosensors on. In this case, the light-emitting devices and the photosensors are arranged such that by means of the measuring device

Tissue perfusion of at least two sites of a tissue or organ of a patient, preferably simultaneously or substantially simultaneously, is measurable. The two parts of the tissue are in some

According to embodiments of the invention not adjacent or by at least one tissue section thereof Tissue perfusion not simultaneously using the

Measuring device according to the invention is measurable separated or spaced apart.

Advantageous further developments of the present invention are the subject matter of subclaims and

Embodiments.

Embodiments of the invention may have one or more of the following features in any combination.

For all subsequent versions, the use of the

Expression "may be" or "may have", etc. synonymous with "is preferably" or "preferably has", etc., and is intended to explain an embodiment of the invention.

As used herein, the term "noninvasive" refers only to interventions on internal structures of the patient, and is to be understood herein as "without the need for interventions on the intestine or other organs in the context of a surgical procedure, that is, an open abdominal wall". By contrast, the term "invasive" means, for example, that a hollow organ has to be opened in order to be able to carry out the measurements In both cases, the abdomen or thorax is open, since the device according to the invention is within one

surgery is used.

Whenever numerical words are mentioned herein, those skilled in the art will understand these as indicating a numerically lower limit. If this does not lead to a contradiction that can be recognized by the person skilled in the art, the person skilled in the art will therefore read, for example, when stating this "One" or "one" always "at least one" or "at least one" with. This understanding is also encompassed by the present invention as the interpretation that a numerical word such as "a" may alternatively be meant as "exactly one" wherever technically possible for those skilled in the art. Both are encompassed by the present invention and apply to all number words used herein.

In some exemplary embodiments of the measuring device according to the invention, at least two light-emitting devices and at least two photosensors are arranged on one, preferably outer, peripheral or outer portion of the

Measuring device arranged. In some exemplary embodiments of the invention, the scope of the measuring device is substantially

circular.

In some exemplary embodiments of the invention, the measuring device has a substantially rod-shaped portion. In this case, located at a first end of the rod-shaped portion, a measuring unit, which the

having light intermittent devices and / or photosensors.

In some exemplary embodiments according to the invention, the measuring device has a measuring unit which

is rod-shaped or has a rod-shaped portion, wherein the light-intermittent devices and / or photosensors are arranged along the rod shape. So can several

Measurements along an organ z. B in the direction of

Intestinal extension) at the same time. In some exemplary embodiments of the invention, there are at a second end of the rod-shaped

Section a holding device and / or at least one

Control section, in which at least one control element is arranged. As a control come all known

Control systems and controllers in question.

In certain inventive, exemplary

Embodiments, the measuring unit of the measuring device is substantially circular and / or has, in particular in

Circumferential direction of the measuring unit, rounded edges. This advantageously reduces the risk that the examined tissue will be injured during the measurements.

In certain inventive, exemplary

Embodiments, the measuring unit is configured such that in use it fits into the lumen of intestinal loops or sections and is suitable for measurement there, or it is configured for this purpose.

In some exemplary embodiments of the invention, the measuring unit is configured such that in use it can be disposed wholly or partially around or around the outer circumference of intestinal loops. In this case, the measuring unit has a recess for gripping at least one surgically stepped intestinal portion or a recess for the

Placing the mesocolon. Intestinal loops are attached to the posterior abdominal wall by means of the intestinal mesentery (mesentery in the area of the small intestine and mesocolon for the large intestine). Through the intestinal gland, blood vessels and nerves reach the intestine. For measurements on the outer wall of the intestine should the Measuring unit be designed so that the intestinal crust is not crushed or otherwise injured.

For example, the measuring unit may have a recess for the intestinal crest and / or be substantially U-shaped or annular with an open section (recess) into which the affected intestinal portion is introduced and which at the same time offers space for the intestinal mesentery.

In certain inventive, exemplary

Embodiments, the recess on at least one further light-emitting device and / or at least one other photosensor to the blood circulation in a

Intestinal section, mesentery and / or mesocolon.

In a further exemplary embodiment, the measuring device according to the invention and / or the measuring unit may be annular or substantially annular in cross-section so as to be arranged inside or around tubular structures. In this case, a portion of the circumference of the annular measuring device and / or the

annular measuring unit can be separated from the scope or detachable therefrom. A detachable or detachable

Section may be particularly advantageous if the

Measurements on the outer wall of a tubular structure are carried out, which holding tissue (such as the intestinal mesentery) or branches, which must not be injured in the measurements.

In some exemplary embodiments of the invention, the light emitting devices and / or the

Photo sensors arranged on the outer wall or an outer portion of the, preferably annular, measuring unit. These Embodiment is particularly useful for measurements on the inner wall of a hollow organ.

In certain inventive, exemplary

Embodiments, the light-emitting devices and / or the photosensors are arranged on the inner wall of the preferably annular measuring unit. This embodiment is particularly useful for measurements on the outer wall of organs. In some exemplary embodiments according to the invention, the measuring device and / or the measuring unit are designed such that they have a length and / or width

are variable. In some exemplary embodiments according to the invention, the latter can be achieved in that the measuring device or the measuring unit is in each case multi-part or has several components, wherein the components of the

Measuring device and / or the measuring unit telescopic

can be designed to be adjustable to each other. In some exemplary embodiments according to the invention, dimensions or shape of the measuring device-or else only the measuring unit alone-can be varied by means of a preferably elastic, inflatable device (such as a tube or a balloon) enclosed by the measuring device. Thus, in a simple manner, the dimensions of the measuring device can be adapted to the organ to be examined.

In certain inventive, exemplary

Embodiments, the measuring device a

Holding device on. The holding device is configured to temporarily fix the examined body structure on the measuring device or measuring unit or the body structure and to hold the measuring device or unit together or in contact.

In some example embodiments of the invention, the measuring unit or a portion thereof are referred to as

Holding device designed.

The measuring unit may, in certain inventive,

Exemplary embodiments should be at least two parts. For example, a first portion is annular and further configured to be disposed about the outside wall of the hollow organ. A second section of the

Measuring device is designed to be arranged in relation to the first portion in the lumen of the hollow organ such that the wall, for example, the intestinal wall, is placed between the first and second portion of the measuring device. The measuring unit may, in some exemplary embodiments of the invention, have a configuration similar to a clamp.

In certain inventive, exemplary

Embodiments, the holding device holds the intestinal wall at the desired position by positive (eg, clamping action) or negative (eg, suction) pressure.

In certain inventive, exemplary

According to embodiments, the measuring device has a sterile, translucent envelope in order to meet the hygiene requirements of surgery. The measuring device may alternatively or additionally be designed sterilizable. In some exemplary embodiments according to the invention, the data transmission between the measuring unit and the processor of the measuring device takes place in a wireless manner. In some example embodiments of the invention, the measurement device may be configured to determine tissue perfusion based on the principles of pulse oximetry. Pulse oximeters use the light absorption behavior of molecules of a fluid to distinguish these molecules from each other. In this case, the pulse oximeter irradiates a tissue with light of defined wavelength / s and intensity by means of a light-emitting device. By absorption through the tissue, the light undergoes a decrease in its

Intensity. In this case, a part of the emitted light beam is reflected.

Photosensors may be in certain inventive

Embodiments be provided to receive both the reflected light (reflection pulse oximetry) in selected wavelengths, as well as the light after irradiation of the

total tissue thickness (transmission pulse oximetry).

In certain embodiments of the invention, the measuring device is configured to be based on the principles of reflection pulse oximetry or the principles of

Transmission pulse oximetry to be used.

The received light generates electrical impulses which are processed in a processor. The processor calculates for predetermined wavelength, the difference between the intensity of the emitted and the received light. It thus determines how much light was absorbed or reflected by the tissue in the observed or selected wavelengths.

In the blood circulation measurement, the differences of the

Absorption spectra of oxygenated hemoglobin

(Oxyhemoglobin) and oxygen-free hemoglobin

(Deoxyhemoglobin) used in pulsating blood to the

To determine oxygen saturation of the blood. Both molecules absorb light with a wavelength of over 600 nm (red or infrared light). Deoxyhemoglobin absorbs light in the red region (660 nm) about 10 times stronger than oxyhemoglobin. The absorption maximum of oxyhemoglobin, however, is in the range of 880-950 nm. Therefore, in medicine

Wavelengths in the red region, around 660 nm, and in the infrared region from 880 to 950 nm are preferred.

Reflection oximetry uses the reflection spectra of oxyhemoglobin and deoxyhemoglobin. The measurement also takes place at 660 nm, since oxyhemoglobin is here

Maturity maximum and the difference to deoxyhemoglobin is greatest. The reference measurement is performed at 890 nm. At this wavelength, the reflectivity of

Oxyhemoglobin and deoxyhemoglobin identical. Since light waves are taken as measurement parameters, very many

Single measurements per unit time are performed. The

Light sources must be switched on and off very quickly.

Since oxyhemoglobin and deoxyhemoglobin absorb different degrees of light in the red and infrared regions, the values determined by the photosensors to calculate the ratio of oxyhemoglobin and deoxyhemoglobin, ie, to determine the oxygen saturation of the hemoglobin. According to the Lambert-Beer law, the concentration of an optically active substance in a solution is proportional to the extinction or reflection when the molecular extinction coefficient and the distance of the light are known. By corresponding calibration curves, the oxygen saturation of the

perfused tissue. Since the proportion of oxygen-rich blood changes as a function of the pulse, the pulsatile blood flow can thus also be measured. Both parameters are important quantities for determining the vitality of the tissue.

This oxygen saturation correlates with the oxygen saturation

Circulatory status of the irradiated tissue.

Underperfused tissues have a lower

Concentration of oxyhemoglobin and a higher concentration of deoxyhemoglobin and thus a lower oxygen saturation.

Some or all embodiments of the invention may include one or more of those mentioned above or below

Have advantages.

Information about the perfusion status of tissues is of great benefit in surgery.

For example, the determination of a sufficient

Perfusion in the gastrointestinal tract before and after

Sewing together two intestinal tracts (anastomosis) of utmost relevance with regard to the chance of a correct healing of the suture. Poorly perfused anastomotic areas may cause the surgical wound to not heal and the seam rises. At best, this leads to a complicated second surgical procedure and in the worst case death of the patient after septic peritonitis

(Peritonitis). The measuring device according to the invention, which allows intraoperative measurements on intestinal loops to determine the most suitable site for an anastomosis, for the reasons mentioned above, the complication rate

Lower intestinal resections. Due to the circular measurement

multiple sites of parts to be anastomosed on both corresponding portions of an anastomosis advantageously results in a circular representation of the blood flow and thus the vitality of lying directly in the seam

Bowel segments. Expected problems with the

Anastomosis healing can be detected during surgery and corrected if necessary.

Advantageously, the blood circulation at several points of an organ or in certain embodiments of various organs (in particular in the abdomen or thorax) are measured substantially simultaneously. This saves time in finding a suitable site for, for example, an intestinal anastomosis or in the search for weak spots at the sutures or underperfused sites in the tissue. The latter can in turn contribute to the risk of infection in certain

surgical interventions and thus to reduce the complication rate. Furthermore, the extent of manipulation of organs may be lower, which is particularly important in pressure-sensitive or -reactive tissues. A further advantage of some exemplary embodiments according to the invention is that the perfusion of internal organs, in particular hollow organs, such as, for example, the intestine, is not impaired. can be determined invasively. That is, intestinal loops need not be cut just to be able to take measurements, as they can also take place on the outer wall of the intestinal loops. This minimizes the cuts that are made to the bowels during a surgical procedure. This also likes the complication rate of a

Lower intestinal surgery.

Another advantage of some invention

Embodiments is because when measurements at the

Outside wall of the intestine the more sensitive inner wall is not irritated.

Another advantage of certain invention

Embodiments consists in the possibility that

Adapt the measuring device to the size and possibly to the shape of the organ to be examined. This can be as above

described, for example by means of a telescopic

Design or by means of at least one balloon, which can change its size or shape by means of gas introduction. Thus, the same device according to the invention can be used for measurements on the stomach, on the small and large intestine. An additional advantage is that through

different reflectance behavior can be measured from the layers of the intestinal wall (e.g., mucosa, muscularis, serosa), whether all intestinal wall layers and thus the whole intestinal wall are included in an anastomosis.

The measuring unit can advantageously have several functions. For example, it may have a holding function for the examined tissue. For this purpose, the measuring unit may have sections which on the outer and on the inner wall of the intestine can be created and face each other. The intestinal wall can be in the desired position by means of clamping or

Suction be kept.

At the same time, the measuring unit can perform pulse oxymetric measurements. These can be the principles of

Transmission pulse oximetry following reflex pulse oximetry or a combination thereof. In the transmission pulse oximeter embodiments, one of the ones emits

opposite portions of the measuring unit light while the other portion has the photosensors, which receives the partially absorbed by tissue light.

In the embodiment as Reflexpulsoxymeter are the

light emitting devices and the photosensors arranged on the same section of the measuring unit.

Advantageously, the measuring device can be made compact by arranging measuring unit, holding device, control section, processor and display device in a single unit to save space. The measurements can thus be performed and read at the affected site in the operative area.

An advantage of the wireless data transfer between sensors and processor of the image processing device may be that there are fewer objects in the operative area. This can reduce the risk of accidents and infection.

The present invention will be described below with reference to FIGS

attached drawing, in which identical reference sign same or similar components designate exemplified. In the partially simplified figures: shows a front side of a measuring unit of the measuring device according to the invention in a first exemplary

embodiment; schematically shows a simplified

Perspective view on the

Measuring device according to the invention in a second exemplary embodiment;

Fig. 3 shows a detail of a supervision

Section of the measuring unit of

measuring device according to the invention of Figure 2 in use.

Fig. 4 shows a simplified schematic one

Cross section of the invention

Measuring device in a third

exemplary embodiment in

Use;

Fig. 5 shows a simplified schematic one

Perspective view of the

Measuring device according to the invention in a fourth exemplary embodiment; schematically shows a simplified

Cross section of the invention

Measuring device in another

exemplary embodiment in

Use; and Fig. 7 shows a simplified schematic one

Perspective view of the

Measuring device according to the invention in a further exemplary embodiment.

Fig. 1 shows the view of the front side of a

Measuring unit 8 of a measuring device 100 according to the invention in a first exemplary embodiment.

The circumference of the measuring unit 8 of Fig. 1 is circular. It has on its outer wall 8a (purely by way of example) four

light-emitting devices 1 and (again pure

by way of example) four photosensors 3. The photosensors 3 are arranged in the immediate vicinity of the light-emitting devices 1 by way of example. In Fig. 1, although the photosensors 3 are arranged circularly (in a plane perpendicular to the plane of the drawing) around the light-emitting devices 1, alternatively, they can be located at any position in or on the

Measuring unit 8 may be arranged, as long as they are from the irradiated with the light emitting device 1 tissue

reflected light (see FIG. 3) can record.

The light-emitting devices 1 and the photosensors 3 are by means of a conductor or cable with a power source

(not shown), a control element 12 (not shown in FIG. 1) and / or a display device 16 (not shown in FIG. 1, see FIG. 2), for example one

Display, connected. The cables come out of the

light-emitting devices 1 and the photosensors 3 from and into a central axis 5b of a rod-shaped portion 5 (not shown in the figure, see Fig. 2) of Measuring device 100 a. In Fig. 1, the cables run radially, first in the interior of transverse struts 5a before entering the

Central axis 5b open. The course of the cable and the cable length are such that in the case of changes in shape or size

Measuring unit 8 the cables are not unduly stretched or bent by these changes. These are

Solutions known in the art, such as

Rail systems, retractable rollers, etc.

The scope of the measuring unit 8 of Fig. 1 is changeable, as already mentioned above. In the example of FIG. 1, this takes place by means of telescoping sections 6 which can be displaced into one another. The transverse struts 5 a can also have a similar mechanism.

However, any other mechanism for varying a circumference or diameter is also encompassed by the present invention, such as elastic inflatable tubes or balloons instead of the telescopic sections 6 and cross braces 5a.

2 shows a perspective, schematically simplified plan view of the measuring device 100 according to the invention in a second exemplary embodiment. The

Measuring device of Fig. 2 has a measuring unit 8 with six light-emitting devices 1 and six photosensors 3 (the number is again by way of example, the illustration

schematically simplified), which on the outer wall 8a

are arranged. The light-emitting devices 1 and photosensors 3 are arranged in a circle around the central axis 5b of the measuring device 100 according to the invention. The

Central axis 5b extends in the interior of the rod-shaped Section 5. In the central axis 5b are the cables which the light-emitting devices 1 and

Photo sensors 3 with a power source (not shown), a control 12 and / or with a

Playback device 16, such as a display connect.

The measuring device 100 of FIG. 2 has only one measuring unit 8, but it may have several, which are for example each annular or of a different shape and are arranged for example at regular intervals and / or at different heights about the rod-shaped portion 5. Such

Design of the measuring device 100 allows

For example, the simultaneous measurement of the blood flow of a longer intestinal tract.

In use, the measuring device 100 is held on its rod-shaped portion 5 and can be manually cut into the lumen 21 of a surgical procedure

Intestinal section are introduced.

By means of, for example, reflection pulse oximetry, oxygen saturation values are determined by the measuring unit 8 which correlate with the perfusion state of the examined tissue

correlate. The determined values are transferred to the processor of the display device 16, there possibly processed or processed and then transmitted to the user.

Fig. 3 shows a simplified schematic detail supervision of a portion of the measuring unit 8 of Fig. 2 in use. In the illustrated section, in turn, four light-emitting devices 1 and four photosensors 3 are shown by way of example. The measuring unit 8 of FIG. 3 operates on the principle of reflection pulse oximetry. From the

Light-emitting device 1, a gut section with light 26 at least one, usually several defined or predetermined wavelengths irradiated. The light is partially reflected by the tissue. The tissue also absorbs light from the individual wavelengths to varying degrees. The extent of light absorption depends on the

Tissue composition and from the wavelength of light. The light reflected from the tissue reaches the photosensors 3. From the quantity and / or quality of the reflection and / or the absorption of the light in each wavelength, the proportion of deoxyhemoglobin and thus the perfusion state of the examined tissue can be determined.

Fig. 4 shows a simplified schematic cross-section of the measuring device according to the invention in a third

exemplary embodiment in use.

Fig. 4 shows the cross-section of a bowel loop with a bowel wall 22 and a gut lumen 21. The bowel loop is surrounded by a bowel mesentery 20 (small intestine mesenteric or mesocolon for large intestine) which surrounds the bowel loops in the

Abdominal cavity hangs. Among other things, blood vessels 23 lead through the intestinal gland 20 to the intestinal loop.

The measuring unit 8 shown in FIG. 4 has a circular cross-section and is at least or exactly two-part. Their parts 8-1 and 8-2 are connected to each other at one end by a hinge 9. At the other end they are adjacent a recess 15. In an inner wall 8b of the measuring unit 8, the light-emitting devices 1 and the

Photo sensors 3 arranged. In use, the measuring unit 8 is opened by separating the two parts 8-1, 8-2 of the measuring unit 8 from one another and thus enlarging the recess 15. Both parts 8-1, 8-2 remain connected by the hinge 9 in connection. A bowel section is pushed into the interior of the measuring unit 8, this is then closed. Even when closed, there is still a recess 15. In this

Recess 15 finds the Darmgekröse 20 place. Thus, this structure is neither squeezed nor damaged during the measurement of oxygen saturation of the intestinal wall.

The illustrated embodiment of the invention is suitable for the non-invasive measurement of oxygen saturation in the intestine, since the measurements only on the outer wall of the

Intestinal loops occur; it is not necessary to have a cut intestine to perform the measurements.

Further, the parts 8-1, 8-2 of the measuring unit 8 at the recess 15 each have at least one light-emitting

Device 1 and at least one photosensor 3 have. In between, the intestinal crest 20 is placed. The light 26 from the light-emitting device 1 radiates through the

Darmgekröse 20 through and is received by the photosensor 3 (according to the principle of transmission pulse oximetry). 5 shows a simplified schematic perspective view of the measuring device 100 according to the invention in a fourth exemplary embodiment. The inventive Measuring device 100 has a measuring unit 8, whose

Light-emitting devices 1 and photosensors 3 are arranged on its outer wall, a rod-shaped portion 5, which has a telescopic element 6, and a

Holding device 14. The control and display device is not shown in the figure.

The exemplary embodiment of FIG. 5 is particularly suitable for the invasive measurement of oxygen saturation in the intestine, in which the measurements on the inner wall of

Intestinal loops occur. The measuring unit 8 is inserted in a cut intestine loop. To facilitate the insertion of the measuring unit 8, the intestinal section to

Investigation with a holding device 14 fixed. The

Holding device 14 may be a pair of pliers or clamp, as shown schematically in Fig. 5. It can additionally or alternatively work, for example with a vacuum, so that the intestinal portion is held by suction at the desired position. The rod-shaped portion 5 can be changed in its length. Thus, the measuring unit 8 can be pushed deeper in the intestinal loop or closer to the operator. For this purpose, for example, again telescopic elements. 6

intended . 6 shows a simplified schematic top view of a cross section of the measuring device 100 according to the invention in another exemplary embodiment in use, which has the same configuration as in FIG. 4, with the exception of a second measuring unit 80. The measuring unit 80 operates on the same principle as the measuring unit 8, but has its light emitting devices and photosensors on an outer wall 80a thereof. The pulse oxymetry Configuration of the measuring device may correspond to that of a reflex and / or a transmission pulse oximeter.

FIG. 7 shows, schematically simplified, a perspective top view of the inventive measuring device 100 of FIG. 5 with a second measuring unit 80, whose

light-emitting devices 1 and photosensors 3 are arranged on their inner wall 80b to make measurements on the outer wall of the intestine. In the illustrated embodiment, both measuring units 8 and 80 may function as holding units when facing each other and placing the intestinal wall therebetween. Again, both are one

Clamping action as well as suction, or a combination thereof, applicable to hold the intestine in the desired location.

LIST OF REFERENCE NUMBERS

100 measuring device

I light-emitting device

3 photosensor

5 rod-shaped portion of the measuring device 5a transverse struts of the rod-shaped portion of

measuring device

5b central axis of the rod-shaped portion of the measuring device

6 telescopic section

7a first end of the rod-shaped section

7b second end of the rod-shaped section

8 measuring unit

8a outer wall of the annular measuring unit

8b inner wall of the annular measuring unit

8-1, 8-2 parts of the measuring unit

9 joint

II control section

12 control

14 holding device

15 recess for gripping at least one

bowel segment

20 Intestinal mesentery (mesentery and / or mesocolon) 21 lumens of a bowel loop

22 intestinal wall

23 blood vessels

26 emitted light

27 reflected light

80 second measuring unit

80a outer wall of the second measuring unit

80b inner wall of the second measuring unit

Claims

Medical measuring device (100) for determining the tissue perfusion with at least two light emitting devices (1) and at least two photosensors (3), wherein the light emitting devices (1) and the photosensors (3) are arranged such that by means of the measuring device (100) Tissue perfusion of at least two points of a tissue is simultaneously measurable.

Measuring device (100) according to claim 1, wherein the

at least two light-emitting devices (1) and the at least two photosensors (3) are arranged on a circumference of the measuring device (100).

Measuring device (100) according to the preceding claims, wherein the measuring device (100) has a substantially rod-shaped portion (5), wherein at a first end of the rod-shaped portion (5) is a measuring unit (8), which the light-intermittent

Device (1) and / or the photosensors (3), and wherein at a second end of the rod-shaped portion, a control section (11) is located, in which at least one control element (12) and / or

at least one holding device (14) is arranged.

Measuring device according to claim 3, wherein the

Measuring unit (100) is substantially circular and / or has rounded edges. Measuring device (100) according to one of claims 3 or 4, wherein the measuring unit (8) is designed to be arranged in the lumen (21) of a bowel loop during use of the measuring device (100).

Measuring device (100) according to one of claims 3 to 5, wherein the measuring unit (8) is designed such that in use it can be arranged around or on the outer circumference of intestinal loops, wherein the measuring unit (8) has a recess (15) for gripping at least one

Gut section or for placing the

Intestinal mesentery (20).

Measuring device (100) according to claim 6, wherein the

Recess (15) at least one further light-emitting device (1) and / or at least one other

Photo sensor (3) to measure the blood flow in a bowel and / or Darmgekröse (20).

Measuring device (100) according to one of the preceding

Claims, wherein the measuring device (10) and / or the measuring unit (8) is substantially annular in order to be arranged around tubular structures, wherein a portion of the circumference of the annular

Measuring device (100) and / or the annular

Measuring unit (8) is separable from the scope or detachably arranged therefrom.

Measuring device (100) according to claim 8, wherein the

light-emitting devices (1) and / or the

Photo sensors (3) on the outer wall of the annular

Measuring unit (8) are arranged. Measuring device (100) according to claim 8, wherein the

light-emitting devices (1) and / or the

Photo sensors (3) on the inner wall of the annular

Measuring unit (8) are arranged

Measuring device (100) according to one of the preceding claims, wherein the measuring device (100) and / or the measuring unit (8) are designed to be variable in their length and / or width

Measuring device (100) according to one of the preceding claims, wherein the measuring device (100) has a

Holding device (14) having the means of

Measuring device (100) examined body structure and the measuring device (100) during the blood flow measurement fixed, holds together or keeps in contact.

Measuring device (100) according to one of the preceding claims, wherein the measuring unit (8) or a portion thereof as a holding device (14) is configured, wherein the measuring device (8) is at least in two parts, wherein a first part is annular around the outer wall of the

Hollow organ can be arranged, and wherein a second part relative to the first part in the lumen of the hollow organ can be arranged.

Measuring device (100) according to one of the preceding claims, wherein the measuring device (100) ein

Reflexpulsoxymeter and / or a transmission pulse oxymeter is.