Kornmann Verena N N, van Ramshorst Bert, Smits Anke B, Bollen Thomas L, Boerma Djamila
Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands,
Int J Colorectal Dis. 2014 Apr;29(4):445-51. doi: 10.1007/s00384-013-1815-5. Epub 2013 Dec 20.
Anastomotic leakage is one of the most life-threatening complications after colonic surgery. Correct diagnosis and treatment is important to reduce morbidity and mortality. An abdominal CT scan is one of the main diagnostic tools in diagnosing anastomotic leaks. The aim of this study was to examine the accuracy of abdominal CT scanning to detect anastomotic leakage and to evaluate the consequences of a false-negative CT outcome.
All consecutive patients who underwent colonic resection for malignant disease between 2009 and 2011 or for benign disease in 2010 were reviewed. Patients in whom a postoperative abdominal CT scan was performed to detect anastomotic leakage were included.
In 97 of 524 patients who underwent colonic surgery, an abdominal CT scan was performed for the suspicion of anastomotic leakage. Overall leakage rate was 10.9 % (n = 57). Mortality rate after leakage was 21.1 % (n = 12). Results from all abdominal CT scans revealed an overall sensitivity of 0.59 (95 % CI 0.43-0.73), a specificity of 0.88 (95 % CI 0.75-0.95), positive predictive value 0.82 (95 % CI 0.64-0.92), negative predictive value 0.70 (95 % CI 0.57-0.81), and an accuracy of 74 %. Delayed reintervention for anastomotic leakage due to a false-negative CT outcome resulted in death in 62.5 % (n = 5).
The sensitivity of abdominal CT scanning after colonic surgery is relatively low. A negative CT scan does not rule out anastomotic leakage. Even with a negative CT scan, we should remain equally alert at clinical deterioration as an argument for timely intervention.
吻合口漏是结肠手术后最危及生命的并发症之一。正确的诊断和治疗对于降低发病率和死亡率至关重要。腹部CT扫描是诊断吻合口漏的主要诊断工具之一。本研究的目的是检验腹部CT扫描检测吻合口漏的准确性，并评估CT结果假阴性的后果。
回顾了2009年至2011年间因恶性疾病或2010年因良性疾病接受结肠切除术的所有连续患者。纳入了进行术后腹部CT扫描以检测吻合口漏的患者。
在524例接受结肠手术的患者中，有97例因怀疑吻合口漏而进行了腹部CT扫描。总体漏出率为10.9%（n = 57）。漏出后的死亡率为21.1%（n = 12）。所有腹部CT扫描的结果显示，总体敏感性为0.59（95%CI 0.43 - 0.73），特异性为0.88（95%CI 0.75 - 0.95），阳性预测值为0.82（95%CI 0.64 - 0.92），阴性预测值为0.70（95%CI 0.57 - 0.81），准确性为74%。由于CT结果假阴性导致吻合口漏的延迟再次干预导致62.5%（n = 5）的患者死亡。
结肠手术后腹部CT扫描的敏感性相对较低。CT扫描阴性不能排除吻合口漏。即使CT扫描为阴性，我们在临床病情恶化时仍应同样警惕，作为及时干预的依据。
