Baker Erin H, Hill Joshua S, Reames Mark K, Symanowski James, Hurley Susie C, Salo Jonathan C
1 Department of Surgery, 2 Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC 28203, USA ; 3 Department of Surgery, Sanger Heart and Vascular Institute, Charlotte, NC 28203, USA ; 4 Department of Cancer Biostatistics, Levine Cancer Institute, 5 Levine Cancer Institute, Carolinas Medical Center, Charlotte Levine Cancer Institute, NC 28204, USA.
J Gastrointest Oncol. 2016 Apr;7(2):181-8. doi: 10.3978/j.issn.2078-6891.2015.074.
Anastomotic leak following esophagectomy is associated with significant morbidity and mortality. As hospital length of stay decreases, the timely diagnosis of leak becomes more important. We evaluated CT esophagram, white blood count (WBC), and drain amylase levels in the early detection of anastomotic leak.
The diagnostic performance of CT esophagram, drain amylase >800 IU/L, and WBC >12,000/µL within the first 10 days after surgery in predicting leak at any time after esophagectomy was calculated.
Anastomotic leak occurred in 13 patients (13%). CT esophagram performed within 10 days of surgery diagnosed six of these leaks with a sensitivity of 0.54. Elevation in drain amylase level within 10 days of surgery diagnosed anastomotic leak with a sensitivity of 0.38. When the CT esophagram and drain amylase were combined, the sensitivity rose to 0.69 with a specificity of 0.98. WBC elevation had a sensitivity of 0.92, with a specificity of 0.34. Among 30 patients with normal drain amylase and a normal WBC, one developed an anastomotic leak.
Drain amylase adds to the sensitivity of CT esophagram in the early detection of anastomotic leak. Selected patients with normal drain amylase levels and normal WBC may be able to safely forgo CT esophagram.
食管切除术后吻合口漏与显著的发病率和死亡率相关。随着住院时间的缩短，及时诊断吻合口漏变得更加重要。我们评估了CT食管造影、白细胞计数（WBC）和引流液淀粉酶水平在早期检测吻合口漏中的作用。
计算术后10天内CT食管造影、引流液淀粉酶>800 IU/L和WBC>12,000/µL在预测食管切除术后任何时间吻合口漏方面的诊断性能。
13例患者（13%）发生吻合口漏。术后10天内进行的CT食管造影诊断出其中6例漏口，敏感性为0.54。术后10天内引流液淀粉酶水平升高诊断吻合口漏的敏感性为0.38。当CT食管造影和引流液淀粉酶联合使用时，敏感性升至0.69，特异性为0.98。白细胞升高的敏感性为0.92，特异性为0.34。在30例引流液淀粉酶和白细胞正常的患者中，1例发生了吻合口漏。
引流液淀粉酶增加了CT食管造影在早期检测吻合口漏中的敏感性。部分引流液淀粉酶水平和白细胞正常的患者可能可以安全地不进行CT食管造影检查。
