Struecker Benjamin, Chopra Sascha, Heilmann Ann-Christin, Spenke Johanna, Denecke Christian, Sauer Igor M, Bahra Marcus, Pratschke Johann, Andreou Andreas, Biebl Matthias
Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Berlin Institute of Health (BIH), Berlin, Germany.
J Gastrointest Surg. 2017 May;21(5):801-806. doi: 10.1007/s11605-017-3384-3. Epub 2017 Feb 15.
Many studies have showed that routine upper gastrointestinal contrast agent examinations (RCE) for testing the patency of the anastomosis after esophagectomy or the stapler line after sleeve gastrectomy cannot be recommended due to low sensitivity. However, the clinical value of RCE after gastrectomy for gastric cancer remains unclear. We have retrospectively analyzed the clinical course of 377 consecutive patients who underwent gastrectomy for gastric cancer in our institution between 2005 and 2015. To date, we have performed a RCE on the fifth postoperative day before removal of the nasogastric tube and return to oral intake. In total, we have observed 14 anastomotic leaks (AL) (4%) after oncologic gastrectomy. Four AL (28.6%) occurred before the scheduled RCE on the fifth postoperative day (POD) and 7 (50%) late AL after POD 5. Three patients (21.4%) without any clinical symptoms were diagnosed by the RCE. Sensitivity of RCE was 50%. A significant percentage of patients with AL was diagnosed by computed tomography (CT) of the abdomen (50%). The standard therapy for AL after gastrectomy was endoscopic stent placement (n = 11), including three cases of stenting after surgical revision. Based on our data, we cannot recommend a RCE after gastrectomy for gastric cancer. The majority of AL occurs before or after a RCE and the sensitivity of the examination is low. In case of clinical suspicion of AL, a CT scan (with oral contrast agent) should be performed. In unclear cases, endoscopy is the preferable method providing the option of direct treatment.
许多研究表明，由于敏感性较低，不建议采用常规上消化道造影剂检查（RCE）来检测食管癌切除术后吻合口的通畅情况或袖状胃切除术后吻合器缝线的情况。然而，胃癌胃切除术后RCE的临床价值仍不明确。我们回顾性分析了2005年至2015年间在我院连续接受胃癌胃切除术的377例患者的临床病程。迄今为止，我们在术后第五天拔除鼻胃管并恢复经口进食前进行了RCE。总体而言，我们在肿瘤性胃切除术后观察到14例吻合口漏（AL）（4%）。4例AL（28.6%）发生在术后第五天预定的RCE之前，7例（50%）为术后第5天之后的迟发性AL。3例（21.4%）无任何临床症状的患者通过RCE被诊断出来。RCE的敏感性为50%。相当比例的AL患者通过腹部计算机断层扫描（CT）被诊断出来（50%）。胃癌胃切除术后AL的标准治疗方法是内镜下放置支架（n = 11），包括3例手术修复后支架置入。根据我们的数据，我们不建议胃癌胃切除术后进行RCE。大多数AL发生在RCE之前或之后，且检查的敏感性较低。如果临床怀疑有AL，应进行CT扫描（口服造影剂）。在情况不明确时，内镜检查是提供直接治疗选择的首选方法。
