Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA 90033, USA.
Surg Endosc. 2010 Aug;24(8):1948-51. doi: 10.1007/s00464-010-0884-6. Epub 2010 Feb 5.
Concern over potential injury to the anastomosis has limited the use of early postoperative endoscopy to diagnose conduit ischemia or anastomotic breakdown. Alternatively, a computed tomography (CT) scan has been suggested as a noninvasive means for identifying these complications. This study aimed to compare CT scan with early endoscopy for diagnosing gastric conduit ischemia or anastomotic breakdown after esophagectomy with cervical esophagogastrostomy.
Between 2000 and 2007, 554 patients underwent an esophagectomy and gastric pull-up with cervical esophagogastrostomy at the University of Southern California. Records were reviewed to identify patients who had undergone endoscopy and CT scan within 24 h of each other during the first three postoperative weeks for suspicion of an ischemic conduit or anastomotic breakdown. The accuracies of CT scan and endoscopy in diagnosing an ischemic conduit were compared.
A total of 76 patients had endoscopy and CT scan for clinical suspicion of conduit ischemia or anastomotic breakdown. Endoscopy was performed without complications in all 76 patients. The postoperative endoscopic findings were normal in 24 of the patients, and none subsequently experienced an ischemic conduit or anastomotic breakdown. Evidence of ischemia was present in 28 patients, 7 of whom had black mucosa throughout the gastric conduit with the anastomosis still intact and required removal of their conduit. The remaining 24 patients had partial or complete anastomotic breakdown. On the CT scan, 23 of the 76 patients showed evidence of conduit ischemia (n = 9) or anastomotic breakdown (n = 14). There was no evidence of ischemia or anastomotic breakdown on CT scan for the 24 patients with normal endoscopy or for 3 of the 7 patients who had their conduit removed for graft necrosis.
A normal CT scan does not rule out the possibility of an ischemic gastric conduit after esophagectomy. Early endoscopy is a safe and accurate method for assessing conduit ischemia.
由于担心吻合口损伤，早期术后内镜检查仅限于诊断管腔缺血或吻合口破裂。或者，有人建议 CT 扫描是一种无创手段，可以识别这些并发症。本研究旨在比较 CT 扫描与早期内镜检查在诊断颈段食管胃吻合术后胃管缺血或吻合口破裂中的作用。
2000 年至 2007 年，南加州大学共进行了 554 例食管癌和胃管颈段食管胃吻合术。回顾病历资料，以确定在术后前 3 周内，有 76 例患者因怀疑有缺血性导管或吻合口破裂而行内镜检查和 CT 扫描，且两次检查在 24 小时内完成。比较 CT 扫描和内镜检查在诊断缺血性导管中的准确性。
76 例患者因临床怀疑导管缺血或吻合口破裂而行内镜和 CT 扫描检查。76 例患者均顺利完成内镜检查，无并发症发生。24 例患者术后内镜检查结果正常，无一例发生缺血性导管或吻合口破裂。28 例患者有缺血证据，其中 7 例胃管的整个吻合口均为黑色黏膜，但仍保持完整，需要切除导管。其余 24 例患者出现部分或完全吻合口破裂。76 例患者中，23 例 CT 扫描显示有导管缺血（9 例）或吻合口破裂（14 例）的证据。24 例内镜检查正常或 7 例因移植物坏死而切除导管的患者，CT 扫描均未见缺血或吻合口破裂的证据。
正常的 CT 扫描不能排除食管切除术后胃管缺血的可能性。早期内镜检查是评估胃管缺血的一种安全、准确的方法。
