Hogan Brian A, Winter Desmond C, Broe David, Broe Patrick, Lee Michael J
Department of Radiology, R.C.S.I. Educational & Research Centre, Beaumont Hospital, Dublin 9, Ireland.
Surg Endosc. 2008 Mar;22(3):767-71. doi: 10.1007/s00464-007-9629-6. Epub 2007 Dec 11.
Anastomotic leaks are a major complication of oesophagogastric surgery. We compare contrast swallow fluoroscopy, computed tomography (CT) with oral contrast and endoscopy in identifying anastomotic leaks following oesophagogastric surgery.
A prospective trial of 38 patients undergoing oesophagogastric resection was undertaken with informed consent and institutional review board (ethics committee) approval. Patients underwent all three investigations (over 24 hours) 1 week postoperatively.
Eight (21%) had clinically apparent leaks. Three pseudo-leaks were suggested on contrast swallow but were confirmed normal on CT and endoscopy. Contrast swallow and CT missed one anastomotic leak each. Endoscopy identified anastomotic defects in three patients, in whom CT and contrast swallow were either normal or conflicting.
Routine tests of anastomotic integrity are unnecessary. When clinically suspected, contrast swallow or CT with oral contrast will identify most leaks. Endoscopy is useful in cases where there are incongruous results.
吻合口漏是食管胃手术的主要并发症。我们比较了食管胃手术后造影剂吞咽透视检查、口服造影剂的计算机断层扫描（CT）和内镜检查在识别吻合口漏方面的效果。
在获得知情同意并经机构审查委员会（伦理委员会）批准后，对38例行食管胃切除术的患者进行了一项前瞻性试验。患者在术后1周接受了所有三项检查（在24小时内完成）。
8例（21%）有临床明显的漏口。造影剂吞咽检查提示3例假性漏口，但CT和内镜检查证实正常。造影剂吞咽检查和CT各漏诊1例吻合口漏。内镜检查发现3例患者存在吻合口缺损，而CT和造影剂吞咽检查结果正常或相互矛盾。
常规检查吻合口完整性没有必要。临床怀疑有漏口时，造影剂吞咽检查或口服造影剂的CT能发现大多数漏口。内镜检查在结果不一致的情况下很有用。
