Gervaz P, Platon A, Buchs N C, Rocher T, Perneger T, Poletti P-A
Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland.
Colorectal Dis. 2013;15(10):1295-300. doi: 10.1111/codi.12305.
Prolonged ileus, low-grade fever and abdominal discomfort are common during the first week after colonic resection. Undiagnosed anastomotic leak carries a poor outcome and computed tomography (CT) scan is the best imaging tool for assessing postoperative abdominal complications. We used a CT scan-based model to quantify the risk of anastomotic leak after colorectal surgery.
A case-control analysis of 74 patients who underwent clinico-radiological evaluation after colorectal surgery for suspicion of anastomotic leak was undertaken and a multivariable analysis of risk factors for leak was performed. A logistic regression model was used to identify determinant variables and construct a predictive score.
Out of 74 patients with a clinical suspicion of anastomotic leak, 17 (23%) had this complication confirmed following repeat laparotomy. In multivariate analysis, three variables were associated with anastomotic leak: (1) white blood cells count > 9 × 10(9) /l (OR = 14.8); (2) presence of ≥ 500 cm(3) of intra- abdominal fluid (OR = 13.4); and (3) pneumoperitoneum at the site of anastomosis (OR = 9.9). Each of these three parameters contributed one point to the risk score. The observed risk of leak was 0, 6, 31 and 100%, respectively, for patients with scores of 0, 1, 2 and 3. The area under the receiver operating characteristic curve for the score was 0.83 (0.72-0.94).
This CT scan-based model seems clinically promising for objective quantification of the risk of a leak after colorectal surgery.
结肠切除术后第一周，肠梗阻持续时间延长、低热和腹部不适较为常见。未确诊的吻合口漏预后较差，计算机断层扫描（CT）是评估术后腹部并发症的最佳影像学工具。我们使用基于CT扫描的模型来量化结直肠手术后吻合口漏的风险。
对74例因怀疑吻合口漏而接受临床放射学评估的结直肠手术患者进行病例对照分析，并对漏出的危险因素进行多变量分析。使用逻辑回归模型识别决定变量并构建预测评分。
在74例临床怀疑有吻合口漏的患者中，17例（23%）在再次剖腹手术后确诊有此并发症。在多变量分析中，有三个变量与吻合口漏相关：（1）白细胞计数>9×10⁹ /升（比值比=14.8）；（2）腹腔内积液≥500立方厘米（比值比=13.4）；（3）吻合口处存在气腹（比值比=9.9）。这三个参数中的每一个都为风险评分贡献一分。评分分别为0、1、2和3的患者，观察到的漏出风险分别为0%、6%、31%和100%。该评分的受试者工作特征曲线下面积为0.83（0.72 - 0.94）。
这种基于CT扫描的模型在临床上似乎有望客观量化结直肠手术后漏出的风险。
