Tonolini Massimo, Bracchi Elena
Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
Insights Imaging. 2017 Aug;8(4):393-404. doi: 10.1007/s13244-017-0559-0. Epub 2017 Jun 19.
Surgical resection represents the mainstay treatment and only potentially curative option for gastric carcinoma, and is increasingly performed laparoscopically. Furthermore, other tumours and selected cases of non-malignant disorders of the stomach may require partial or total gastrectomy. Often performed in elderly patients, gastric resection remains a challenging procedure, with significant morbidity (14-43% complication rate) and non-negligible postoperative mortality (approximately 3%). This paper provides an overview of contemporary surgical techniques for non-bariatric gastric resection, reviews and illustrates the expected postoperative imaging appearances, common and unusual complications after partial and total gastrectomy. Albeit cumbersome or unfeasible in severely ill or uncooperative patients, contrast fluoroscopy remains useful to rapidly check for anastomotic patency and integrity. Currently, emphasis is placed on multidetector CT, which comprehensively visualizes the surgically altered anatomy and consistently detects complications such as anastomotic leaks and fistulas, duodenal stump leakage, afferent loop syndrome, haemorrhages, pancreatic fistulas and porto-mesenteric venous thrombosis. Our aim is to help radiologists become familiar with early postoperative imaging, in order to understand the surgically altered anatomy and to differentiate between expected imaging appearances and abnormal changes heralding iatrogenic complications, thus providing a consistent basis for correct choice between conservative, interventional or surgical treatment.
• Radical gastrectomy is associated with frequent postoperative morbidity and non-negligible mortality. • In cooperative patients fluoroscopy allows checking for anastomotic patency and leaks. • Multidetector CT with / without oral contrast comprehensively visualizes the operated abdomen. • Awareness of surgically altered anatomy and expected postoperative appearances is warranted. • Main complications include anastomotic and duodenal leaks, haemorrhages and pancreatic fistulas.
手术切除是胃癌的主要治疗方法，也是唯一可能治愈的选择，且越来越多地通过腹腔镜进行。此外，其他肿瘤以及胃的某些非恶性疾病病例可能需要部分或全胃切除术。胃切除术常在老年患者中进行，仍然是一项具有挑战性的手术，并发症发生率较高（14 - 43%），术后死亡率也不容忽视（约3%）。本文概述了非减重性胃切除的当代手术技术，回顾并阐述了术后预期的影像学表现、部分和全胃切除术后常见及不常见的并发症。尽管对于病情严重或不配合的患者来说，对比荧光透视检查操作繁琐或不可行，但它对于快速检查吻合口通畅性和完整性仍很有用。目前，重点在于多排CT，它能全面显示手术改变的解剖结构，并能持续检测诸如吻合口漏和瘘、十二指肠残端漏、输入袢综合征、出血、胰瘘和门静脉肠系膜静脉血栓形成等并发症。我们的目的是帮助放射科医生熟悉术后早期影像学表现，以便理解手术改变的解剖结构，并区分预期的影像学表现与预示医源性并发症的异常变化，从而为在保守、介入或手术治疗之间做出正确选择提供一致的依据。
• 根治性胃切除术术后并发症频发，死亡率不容忽视。• 对于配合的患者，荧光透视检查可用于检查吻合口通畅性和漏出情况。• 口服对比剂或不口服对比剂的多排CT能全面显示手术过的腹部。• 有必要了解手术改变的解剖结构和术后预期表现。• 主要并发症包括吻合口和十二指肠漏、出血和胰瘘。
