Lee Chang Ho, Kim Jong Hun, Lee Min Ro
Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea.
J Korean Surg Soc. 2012 Apr;82(4):227-31. doi: 10.4174/jkss.2012.82.4.227. Epub 2012 Mar 27.
The aim of this study was to determine the incidence and duration of postoperative pneumoperitoneum on plain radiographs and to identify the radiologic findings associated with anastomotic leakage.
A retrospective analysis was conducted on plain radiographs of 384 patients who underwent intra-abdominal anastomoses between March 2005 and December 2008.
Of the 384 patients, 93 patients (24.2%) had postoperative pneumoperitoneums. Of the 93 patients, 86 patients (92.5%) had physiologic pneumoperitoneums and 7 patients (7.5%) had pneumoperitoneums associated with anastomotic leakage. The initial air height was significantly greater in the leakage group than the physiologic air group (12.16 ± 7.65 mm vs. 7.71 ± 5.08 mm, P = 0.04). The area under the receiver operating characteristic curve of the initial height of free air for anastomotic leakage was 0.69 (95% confidence interval, 0.59 to 0.78). The best cut-off point was 11.7 mm. The height of the pneumoperitoneum increased with time in the leakage group. Ileus was significantly more prevalent in the leakage group than the physiologic air group (P < 0.01).
Postoperative pneumoperitoneum is a common phenomenon after abdominal surgery. An initial air height >11.7 mm, increasing air height over time, and the presence of ileus on plain radiographs suggest a high likelihood of anastomotic leakage.
本研究旨在确定术后气腹在平片上的发生率及持续时间，并识别与吻合口漏相关的影像学表现。
对2005年3月至2008年12月期间接受腹腔内吻合术的384例患者的平片进行回顾性分析。
384例患者中，93例（24.2%）出现术后气腹。在这93例患者中，86例（92.5%）为生理性气腹，7例（7.5%）为与吻合口漏相关的气腹。漏出组的初始气腹高度显著高于生理性气腹组（12.16±7.65mm对7.71±5.08mm，P = 0.04）。吻合口漏时游离气体初始高度的受试者操作特征曲线下面积为0.69（95%置信区间，0.59至0.78）。最佳截断点为11.7mm。漏出组气腹高度随时间增加。肠梗阻在漏出组中的发生率显著高于生理性气腹组（P < 0.01）。
术后气腹是腹部手术后的常见现象。平片上初始气腹高度>11.7mm、气腹高度随时间增加以及存在肠梗阻提示吻合口漏的可能性较大。
