Aday Ulaş, Gündeş Ebubekir, Çiyiltepe Hüseyin, Çetin Durmuş A, Gülmez Selçuk, Senger Aziz S, Değer Kamuran C, Duman Mustafa
Department of Gastroenterological Surgery, Kartal Kosuyolu High Speciality Education and Training Hospital, İstanbul,Turkey.
Contemp Oncol (Pozn). 2017;21(3):224-227. doi: 10.5114/wo.2017.70112. Epub 2017 Sep 29.
Examination of esophagojejunal (EJ) anastomosis with aqueous contrast swallow after total gastrectomy is still routinely conducted by many centres. The present study aimed to answer the question: Is it necessary to evaluate EJ anastomosis in terms of leakage by having every patient drink oral contrast agent before initiation of oral food intake after total gastrectomy (TG) performed due to gastric cancer?
Clinical and radiological results of patients on whom total gastrectomy was performed due to gastric cancer between January 2013 and December 2016 were retrospectively reviewed. Diagnostic method used for patients in whom leak developed and therapeutic interventions were assessed. Evaluation results from aqueous contrast agent and clinical, laboratory, and tomographic findings were studied.
Sixty of the 69 patients who underwent total gastrectomy with a diagnosis of gastric adenocarcinoma swallowed aqueous contrast agent on postoperative day 7 ±2 days and were evaluated in terms of anastomotic leak. Leak developed in 14 patients (20.2 %), 10 of whom ingested contrast agent. Leak was identified in 6 of those patients; however, diagnosis was made with multislice computed tomography (CT) in four patients (40%). The sensitivity of the examination with aqueous contrast agent was 60%.
Evaluating anastomotic leak with aqueous contrast agent after TG has low sensitivity, and it would be wise to resort to this procedure in cases with clinical suspicion, rather than routinely performing it in every patient.
许多中心仍常规对全胃切除术后的食管空肠（EJ）吻合口进行水溶性造影剂吞咽检查。本研究旨在回答以下问题：对于因胃癌行全胃切除术（TG）的患者，在开始经口进食前让每位患者饮用口服造影剂以评估EJ吻合口漏是否必要？
回顾性分析2013年1月至2016年12月间因胃癌行全胃切除术患者的临床和影像学结果。评估发生吻合口漏患者的诊断方法及治疗干预措施。研究水溶性造影剂的评估结果以及临床、实验室和断层扫描结果。
69例诊断为胃腺癌并接受全胃切除术的患者中，60例在术后7±2天吞咽了水溶性造影剂，并接受了吻合口漏评估。14例患者（20.2%）发生了吻合口漏，其中10例摄入了造影剂。这些患者中有6例被发现有漏；然而，4例患者（40%）通过多层计算机断层扫描（CT）确诊。水溶性造影剂检查的敏感性为60%。
全胃切除术后用水溶性造影剂评估吻合口漏的敏感性较低，对于临床怀疑有漏的病例采用该检查方法是明智的，而不是对每位患者都常规进行。
