Bruno Onorina, Brancatelli Giuseppe, Sauvanet Alain, Vullierme Marie Pierre, Barrau Vincent, Vilgrain Valérie
Université Paris 7 Denis Diderot, Paris F-75018, France.
AJR Am J Roentgenol. 2009 Sep;193(3):W175-80. doi: 10.2214/AJR.08.1800.
The purpose of this study was to evaluate the sensitivity and specificity of routine performance of CT on postoperative day 7 in patients at high risk of pancreatic fistula after pancreaticoduodenectomy.
Two radiologists analyzed images from CT examinations of 50 patients with soft pancreas 7 days after pancreaticoduodenectomy. Pancreatic fistula was defined at CT as a fluid collection close to the pancreaticogastric or pancreaticojejunal anastomosis. Clinicobiologic criteria for the diagnosis of pancreatic fistula were drain output of any measurable volume of fluid on or after postoperative day 3 that had an amylase content more than three times the serum amylase activity. The final diagnosis of pancreatic fistula was rendered on the basis of clinicobiologic data at hospital discharge or at first readmission.
At hospital discharge or at first readmission, 27 of 50 patients (54%) had a pancreatic fistula. On postoperative day 7, 30 patients (60%) had a total of 51 fluid collections, and CT showed a fluid collection close to the pancreaticogastric or pancreaticojejunal anastomosis in 21 of 51 cases. CT had a sensitivity of 63% (17/27 patients) and a specificity of 83% (19/23 patients) for the diagnosis of pancreatic fistula with four false-positive and 10 false-negative findings. The diagnosis of pancreatic fistula on the basis of clinicobiologic criteria on postoperative day 7 was made in 22 of 27 patients (81%), whereas five cases were false-negative. Four of these patients had CT evidence of pancreatic fistula.
In patients at high risk who have undergone pancreaticoduodenectomy, systematic postoperative CT may be proposed as a complementary tool in the diagnosis of pancreatic fistula, particularly for detection of clinically occult pancreatic fistula.
本研究旨在评估胰十二指肠切除术后胰瘘高危患者术后第7天进行常规CT检查的敏感性和特异性。
两名放射科医生分析了50例胰腺质地柔软的患者在胰十二指肠切除术后7天的CT检查图像。CT将胰瘘定义为靠近胰胃或胰空肠吻合口的液体积聚。胰瘘诊断的临床生物学标准为术后第3天及以后任何可测量体积的引流液，其淀粉酶含量超过血清淀粉酶活性的三倍。胰瘘的最终诊断基于出院时或首次再入院时的临床生物学数据。
出院时或首次再入院时，50例患者中有27例（54%）发生胰瘘。术后第7天，30例患者（60%）共有51处液体积聚，CT显示51例中有21例液体积聚靠近胰胃或胰空肠吻合口。CT诊断胰瘘的敏感性为63%（17/27例患者），特异性为83%（19/23例患者），有4例假阳性和10例假阴性结果。27例患者中有22例（81%）根据术后第7天的临床生物学标准诊断为胰瘘，而5例为假阴性。其中4例患者有CT证据显示存在胰瘘。
对于接受胰十二指肠切除术的高危患者，术后系统性CT检查可作为诊断胰瘘的辅助工具，特别是用于检测临床隐匿性胰瘘。
