Upponi S, Ganeshan A, D'Costa H, Betts M, Maynard N, Bungay H, Slater A
Department of Clinical Radiology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DZ, UK.
Br J Radiol. 2008 Jul;81(967):545-8. doi: 10.1259/bjr/30515892.
The purpose of this study was to directly compare CT with fluoroscopy for the diagnosis of occult anastomotic leak following oesophagectomy. Patients undergoing oesophagectomy and gastric conduit formation for the treatment of oesophageal cancer were eligible for inclusion. Imaging was performed 6-8 days post-operatively. Patients underwent multislice CT examination of the chest and abdomen with a bolus of oral contrast, followed by fluoroscopic water-soluble contrast swallow (with subsequent use of barium if this was normal). The studies were reviewed by a consultant radiologist, who was blinded to the results of the other modality. Images were reported as showing "no leak", "possible leak" or "definite leak". The presence of mediastinal gas or fluid or extraluminal contrast at CT was recorded. The clinical outcome after reinstituition of oral intake was used as a reference standard. Patient preference for modality was recorded. 52 patients were recruited. Four were found to have leak on CT and fluoroscopy. 11 had possible leak at CT, but normal fluoroscopy: 2 of these had a leak confirmed later, whereas 9 had no leak. 37 had normal CT and fluoroscopy findings, and remained clinically well. The sensitivity, specificity, positive and negative predictive values were 100%, 80%, 40% and 100%, respectively, for CT, and 67%, 100%, 100% and 96%, respectively, for fluoroscopy. The positive predictive value of mediastinal air, air/fluid and extraluminal contrast were 25%, 75% and 50%, respectively. 35 patients found CT more tolerable. In conclusion, CT was better tolerated and more sensitive but less specific than fluoroscopy for detecting occult anastomotic leak.
本研究的目的是直接比较CT与荧光透视法在诊断食管癌切除术后隐匿性吻合口漏方面的效果。因食管癌接受食管切除术并构建胃管道的患者符合纳入标准。术后6 - 8天进行影像学检查。患者先口服造影剂行胸部和腹部多层CT检查，随后行荧光透视水溶性造影剂吞咽检查（若结果正常则后续使用钡剂）。研究由一位放射科顾问医师进行评估，该医师对另一种检查方式的结果不知情。图像报告分为“无漏”“可能有漏”或“确定有漏”。记录CT检查时纵隔内气体、液体或腔外造影剂的情况。恢复经口进食后的临床结果作为参考标准。记录患者对检查方式的偏好。共招募了52例患者。4例在CT和荧光透视检查中均发现有漏。11例CT检查显示可能有漏，但荧光透视检查正常：其中2例后来证实有漏，而9例无漏。37例CT和荧光透视检查结果均正常，且临床情况良好。CT检查的灵敏度、特异度、阳性预测值和阴性预测值分别为100%、80%、40%和100%，荧光透视检查的相应值分别为67%、100%、100%和96%。纵隔内气体、气/液和腔外造影剂的阳性预测值分别为25%、75%和50%。35例患者觉得CT检查更易耐受。总之，在检测隐匿性吻合口漏方面，CT检查耐受性更好、更敏感，但特异度低于荧光透视法。
