Igor Jeroukhimov, Poluksht Natan, Siegelmann-Danieli Nava, Lavy Ron, Wassermann Ilan, Halpern Zvi, Gold-Deutch Ruth, Halevy Ariel
Division of Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Isr Med Assoc J. 2010 Sep;12(9):560-2.
One of the ominous complications following proximal gastrectomy or total gastrectomy is a leak from the esophagogastric or esophagojejunal anastomosis. An upper gastrointestinal swallow study is traditionally performed to confirm the anastomotic patency and lack of any leak before oral feeding can be initiated.
To challenge the routine use of UGISs following proximal or total gastrectomy in order to check the integrity of the gastroesophageal or jejunoesophageal anastomosis.
The charts of 99 patients who underwent PG or TG for malignant pathology were retrospectively reviewed. UGISs were performed on day 6 following surgery using a water-soluble material.
The UGISs were normal in 95 patients, with none displaying any complication related to the gastroesophageal or jejunoesophageal anastomosis. All four patients who experienced a leak from the anastomosis had an early stormy postoperative course.
Routine use of an UGIS to detect a leak following PG orTG is not justified. UGIS should be performed whenever signs of abdominal sepsis develop following this type or surgery.
近端胃切除术或全胃切除术后一个严重的并发症是食管胃或食管空肠吻合口漏。传统上，在开始经口进食前，需进行上消化道吞咽造影检查以确认吻合口通畅且无任何渗漏。
对近端或全胃切除术后常规使用上消化道吞咽造影检查以检查胃食管或空肠食管吻合口完整性提出质疑。
回顾性分析99例因恶性病变接受近端胃切除术或全胃切除术患者的病历。术后第6天使用水溶性造影剂进行上消化道吞咽造影检查。
95例患者的上消化道吞咽造影检查结果正常，均未显示与胃食管或空肠食管吻合口相关的任何并发症。4例发生吻合口漏的患者术后早期病情均不稳定。
常规使用上消化道吞咽造影检查来检测近端胃切除术或全胃切除术后的吻合口漏是不合理的。当此类手术后出现腹部感染迹象时，应进行上消化道吞咽造影检查。
