Swanson Jonathan O, Levine Marc S, Redfern Regina O, Rubesin Stephen E
Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA.
AJR Am J Roentgenol. 2003 Aug;181(2):415-20. doi: 10.2214/ajr.181.2.1810415.
The purpose of this study was to determine the usefulness of a high-density (250% weight/volume) barium compared with a water-soluble contrast agent for the detection of esophageal leaks in patients who had undergone esophagogastrectomy, total gastrectomy, or total laryngectomy.
A search of our radiology database from 1998 to 2001 revealed 46 eligible radiographic studies performed using a water-soluble contrast agent alone or a water-soluble contrast agent followed by barium that showed leaks in patients who had undergone esophagogastrectomy, total gastrectomy, or total laryngectomy. The images were reviewed to determine the morphology of the leaks (i.e., blind-ending tracks, sealed-off collections, or free extravasation of contrast material). Medical records were also reviewed to determine whether detection of the leaks seen on the radiographic studies affected patient management.
Of the 46 leaks seen on radiographic studies, 23 (50%) were detected with a water-soluble contrast agent and 23 (50%) were detected only with high-density barium. Of the 23 leaks visualized with water-soluble contrast media, six (26%) were characterized by blind-ending tracks, 14 (61%) by sealed-off collections, and three (13%) by free extravasation of contrast material into the mediastinum or neck. Of the 23 leaks visualized only with high-density barium, 19 (83%) were characterized by blind-ending tracks and four (17%) by sealed-off collections. Thus, leaks detected only on images obtained with high-density barium were significantly more likely to be characterized by blind-ending tracks than those detected on images obtained with a water-soluble contrast agent (p = 0.0007). Of the 33 patients with clinical follow-up, the findings seen on these imaging studies affected management in 12 (86%) of 14 patients with leaks depicted by water-soluble contrast media and in 10 (53%) of 19 with leaks depicted only by high-density barium.
Our findings support the use of high-density barium as part of the routine postoperative radiographic examination when no leaks are detected on images obtained with a water-soluble contrast agent.
本研究旨在确定与水溶性造影剂相比，高密度（250%重量/体积）钡剂在检测接受食管胃切除术、全胃切除术或全喉切除术患者食管漏方面的效用。
检索我们1998年至2001年的放射学数据库，发现46项符合条件的影像学研究，这些研究单独使用水溶性造影剂或先使用水溶性造影剂后使用钡剂，显示接受食管胃切除术、全胃切除术或全喉切除术的患者存在漏口。对图像进行评估以确定漏口的形态（即盲端瘘管、封闭性积液或造影剂自由外渗）。还查阅了病历，以确定影像学研究中发现的漏口是否影响患者的治疗管理。
在影像学研究中发现的46处漏口中，23处（50%）用水溶性造影剂检测到，23处（50%）仅用高密度钡剂检测到。在用水溶性造影剂显示的23处漏口中，6处（26%）表现为盲端瘘管，14处（61%）为封闭性积液，3处（13%）为造影剂自由外渗至纵隔或颈部。在仅用高密度钡剂显示的23处漏口中，19处（83%）表现为盲端瘘管，4处（17%）为封闭性积液。因此，仅在高密度钡剂图像上检测到的漏口比在水溶性造影剂图像上检测到的漏口更有可能表现为盲端瘘管（p = 0.0007）。在33例有临床随访的患者中，这些影像学研究结果影响了14例用水溶性造影剂显示漏口患者中的12例（86%）以及19例仅用高密度钡剂显示漏口患者中的10例（53%）的治疗管理。
我们的研究结果支持在用水溶性造影剂的图像上未检测到漏口时，将高密度钡剂作为术后常规影像学检查的一部分使用。
