Malgras Brice, Placé Vinciane, Dohan Anthony, Lo Dico Réa, Duron Sandrine, Soyer Philippe, Pocard Marc
Department of Digestive Surgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.
Department of Digestive Surgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France.
World J Surg. 2017 Jan;41(1):56-63. doi: 10.1007/s00268-016-3648-1.
Postoperative pneumoperitoneum after abdominal surgery represents a diagnostic challenge. This study was designed to analyze the appearance of pneumoperitoneum on computed tomography after uncomplicated abdominal surgery through laparotomy.
The database of the department of digestive surgery was retrospectively queried to identify all patients who underwent abdominal surgery through laparotomy during a 13-month period. This initial search retrieved a total of 384 consecutive patients. Criteria for inclusion in this study were: (a) the operation was performed in our institution, (b) the patient had computed tomography examination postoperatively, and (c) the patient had no postoperative grade ≥3 complication.
Postoperative pneumoperitoneum was visible in 38/80 patients (47.5 %), with a mean volume of 15 ± 22.8 (SD) cm and multiple locations in 32/38 patients (84 %). Postoperative pneumoperitoneum was observed in 22/26 patients (85 %) until day 5 postoperative, 14/34 patients (41 %) between day 6 and day 15 postoperative, and in 2/21 patients (9.5 %) after day 15 postoperative. Its volume decreased when the time interval between surgery and computed tomography increased. Results of multivariate analysis showed that the time interval between surgery and computed tomography was the single independent variable that was associated with the presence of postoperative pneumoperitoneum.
Postoperative pneumoperitoneum is a frequent finding on computed tomography in the early period following abdominal surgery and commonly with multiple locations. Although commonly observed before day 5 postoperative, its presence must be considered as an alarming finding after day 7 postoperative, if present in a single location with a volume >20 cm.
腹部手术后的术后气腹是一项诊断挑战。本研究旨在分析经剖腹术进行的非复杂性腹部手术后，气腹在计算机断层扫描上的表现。
对消化外科数据库进行回顾性查询，以识别在13个月期间接受剖腹术腹部手术的所有患者。初步搜索共检索到384例连续患者。本研究纳入标准为：（a）手术在我们机构进行，（b）患者术后进行了计算机断层扫描检查，（c）患者术后无≥3级并发症。
80例患者中有38例（47.5%）可见术后气腹，平均体积为15±22.8（标准差）cm，38例患者中有32例（84%）气腹位于多个部位。术后第5天前，26例患者中有22例（85%）观察到术后气腹；术后第6天至第15天，34例患者中有14例（41%）观察到；术后第15天后，21例患者中有2例（9.5%）观察到。手术与计算机断层扫描之间的时间间隔增加时，气腹体积减小。多变量分析结果显示，手术与计算机断层扫描之间的时间间隔是与术后气腹存在相关的单一独立变量。
术后气腹是腹部手术后早期计算机断层扫描中常见的表现，且通常位于多个部位。虽然术后第5天前常见，但如果术后第7天后气腹出现在单一部位且体积>20 cm，则必须将其视为一个警示性发现。
