Madan A K, Stoecklein H H, Ternovits C A, Tichansky D S, Phillips J C
Department of Surgery, University of Tennessee Health Science Center, 956 Court Avenue, Room G210, Memphis, TN 38163, USA.
Surg Endosc. 2007 Feb;21(2):194-6. doi: 10.1007/s00464-005-0700-x. Epub 2006 Nov 21.
The utility of routine upper gastrointestinal (UGI) studies after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a matter of great debate. Because the morbidity and mortality rates associated with an unrecognized postoperative leak are high after LRYGB, diagnosis of a postoperative leak earlier would be of benefit. Clinical signs, however, may predict the diagnosis of a postoperative leak more often. This study explored the hypothesis that UGI studies are more predictive than clinical signs for the early diagnosis of a postoperative leak after LRYGB.
All patients who underwent LRYGB at the authors' institution were included in this study. Charts were reviewed to examine immediate clinical signs (heart rate, temperature, and white blood cell count within the first 24 h), UGI studies, and clinical course. Sensitivity, specificity, positive predictive value, negative predictive value, and efficiency of clinical signs and UGI studies were calculated.
This study included 245 patients with a 3% rate of leak. The positive and negative predictive value of UGI studies were 67% and 99%, respectively. Only an elevated white blood count had a better predictive value (100% for negative predictive value). The efficiency of UGI studies (98%) was better than that of heart rate (83%), white blood count (8%), or temperature (95%).
According to our data, UGI studies are the most predictive of an early leak diagnosis. Clinical signs alone may not be as useful in predicting leaks early after laparoscopic gastric bypasses. Routine early postoperative UGI studies are a reasonable approach to predicting leaks after LRYGB.
腹腔镜Roux-en-Y胃旁路术（LRYGB）后常规上消化道（UGI）检查的效用存在很大争议。由于LRYGB术后未被识别的吻合口漏相关的发病率和死亡率很高，更早诊断术后吻合口漏会有益处。然而，临床体征可能更常预测术后吻合口漏的诊断。本研究探讨了UGI检查比临床体征更能预测LRYGB术后早期吻合口漏诊断的假设。
纳入在作者所在机构接受LRYGB的所有患者。查阅病历以检查即刻临床体征（术后24小时内的心率、体温和白细胞计数）、UGI检查及临床病程。计算临床体征和UGI检查的敏感性、特异性、阳性预测值、阴性预测值及效能。
本研究纳入了245例患者，吻合口漏发生率为3%。UGI检查的阳性和阴性预测值分别为67%和99%。只有白细胞计数升高具有更好的预测价值（阴性预测值为100%）。UGI检查的效能（98%)优于心率（83%）、白细胞计数（8%）或体温（95%）。
根据我们的数据，UGI检查对早期吻合口漏诊断的预测性最强。单纯临床体征在预测腹腔镜胃旁路术后早期吻合口漏方面可能没那么有用。术后常规早期UGI检查是预测LRYGB术后吻合口漏的合理方法。
