计算机断层扫描与上消化道荧光透视在诊断减肥手术后吻合钉线漏方面的比较
Computed tomography scan versus upper gastrointestinal fluoroscopy for diagnosis of staple line leak following bariatric surgery.
作者信息
Bingham Jason, Shawhan Robert, Parker Ross, Wigboldy Jay, Sohn Vance
机构信息
Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA.
Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA.
出版信息
Am J Surg. 2015 May;209(5):810-4; discussion 814. doi: 10.1016/j.amjsurg.2015.01.004. Epub 2015 Feb 14.
BACKGROUND
The best radiographic modality to diagnose staple line leaks following bariatric surgery remains controversial. Two common studies used are upper gastrointestinal (UGI) fluoroscopy and computed tomography (CT). This study sought to determine the better modality in detecting clinically significant postoperative leaks.
METHODS
This retrospective review was performed of patients undergoing imaging for suspected staple line leaks following bariatric surgery. These studies were reinterpreted by 2 radiologists who were blinded to the original findings.
RESULTS
Six hundred nineteen radiographic "leak tests" were selectively performed following bariatric procedures at our institution between January 2005 and December 2011. CT was found to have a sensitivity of 95% (95% confidence interval [CI] 81.8 to 99.1) and a specificity of 100% (95% CI 93.1 to 100) in diagnosing postoperative leaks, while UGI demonstrated a sensitivity of 79.4% (95% CI 61.6 to 90.0) and a specificity of 95% (95% CI 85.2 to 98.7).
CONCLUSION
CT is a superior modality compared with UGI for detecting staple line leaks following bariatric surgery.
背景
在减肥手术后，用于诊断吻合钉线渗漏的最佳影像学检查方式仍存在争议。常用的两项检查是上消化道（UGI）荧光透视检查和计算机断层扫描（CT）。本研究旨在确定哪种检查方式在检测具有临床意义的术后渗漏方面更具优势。
方法
对减肥手术后因怀疑吻合钉线渗漏而接受影像学检查的患者进行回顾性研究。由2名对原始检查结果不知情的放射科医生重新解读这些检查结果。
结果
2005年1月至2011年12月期间，在我们机构对减肥手术后的患者选择性地进行了619次影像学“渗漏检查”。结果发现，CT诊断术后渗漏的敏感性为95%（95%置信区间[CI]81.8至99.1），特异性为100%（95%CI93.1至100）；而UGI的敏感性为79.4%（95%CI61.6至90.0），特异性为95%（95%CI85.2至98.7）。
结论
在检测减肥手术后的吻合钉线渗漏方面，与UGI相比，CT是一种更具优势的检查方式。
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