Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Ann Surg Oncol. 2018 Apr;25(4):1061-1068. doi: 10.1245/s10434-017-6327-z. Epub 2018 Jan 9.
Contrast esophagography often is performed to screen for anastomotic leakage (AL) after esophagectomy. However, its sensitivity remains low. Adverse events also have been reported. This report describes a new screening method to detect AL on computed tomography (CT) after esophagectomy.
From January 2012 to December 2015, 185 patients with esophageal cancer underwent surgical resection at the authors' institution. The study comparatively reviewed patient characteristics, surgical outcomes, and findings from postoperative CT images and contrast esophagrams of 142 patients who underwent esophagectomy followed by primary gastric conduit reconstruction through a posterior mediastinum route.
In this study, 24 patients (15.5%) had AL (leakage-positive group), and 120 patients (84.5%) did not (leakage-negative group). Both groups had comparable backgrounds. The number of air bubbles around the anastomotic site and the mediastinal space on postoperative CT images were significantly greater in the leakage-positive group than in the leakage-negative group. The cutoff value for the number of air bubbles required for a positive diagnosis of AL ("air bubble sign") was calculated to be 3 by receiver operating characteristic curve. Compared with contrast esophagography, the air bubble sign on CT demonstrated a significantly higher sensitivity (86.4 vs. 50.0%) and an equivalent specificity (95.8 vs. 100.0%). Contrast esophagography altered the postoperative management of only five patients (3.5%).
A positive air bubble sign on CT is an objective and noninvasive screening method for AL after esophagectomy for esophageal cancer and may replace contrast esophagography as a screening test for AL.
对比食管造影术常用于筛查食管切除术后吻合口漏（AL）。然而，其敏感性仍然较低。也有报道称存在不良事件。本报告描述了一种新的筛查方法，即在食管癌手术后通过 CT 检测吻合口漏。
2012 年 1 月至 2015 年 12 月，作者所在机构对 185 例食管癌患者进行了手术切除。本研究比较了 142 例患者的临床特征、手术结果、术后 CT 图像和对比食管造影的结果，这些患者均接受了经后纵隔途径的原发性胃管重建的食管切除术。
在本研究中，有 24 例患者（15.5%）发生 AL（漏出阳性组），120 例患者（84.5%）未发生 AL（漏出阴性组）。两组背景相当。阳性组术后 CT 图像上吻合口周围和纵隔间隙的气泡数量明显多于阴性组。通过受试者工作特征曲线计算出“气泡征”的阳性诊断所需的气泡数量的截断值为 3。与对比食管造影相比，CT 上的气泡征显示出更高的敏感性（86.4%比 50.0%）和等效的特异性（95.8%比 100.0%）。对比食管造影仅改变了 5 例患者（3.5%）的术后管理。
CT 上的阳性气泡征是食管癌术后吻合口漏的一种客观、非侵入性的筛查方法，可能取代对比食管造影作为吻合口漏的筛查试验。
