Xu Tim, Rosculet Nicholas, Steele Kimberley, Auster Martin
Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
BJR Case Rep. 2016 Jul 22;3(1):20160076. doi: 10.1259/bjrcr.20160076. eCollection 2017.
Bariatric surgery patients commonly undergo post-operative fluoroscopic evaluation for complications, including leaks, in order to progress with oral intake and recovery. As one of the most severe and potentially life-threatening complications, leaks occur in as many as 5% of bariatric surgery patients. Several characteristics of these patients complicate the detection of leaks, including large body habitus and limited mobility. The early detection of leaks can lead to significant reductions in morbidity and mortality in bariatric surgery patients. In a retrospective case series of 619 patients, of whom 20 had experienced a leak, CT scan had a sensitivity of 95% and specificity of 100%, while upper gastrointestinal (UGI) evaluation had an inferior sensitivity of 79% and specificity of 95%. In addition to greater sensitivity and specificity, CT scan can identify other complications, such as abscesses and bowel obstructions. Also, UGI evaluation is notably more dependent on patient and technologist compliance, resulting in suboptimal examinations. UGI, on the other hand, may help further define the size and more precise location of the leak, but typically cannot be performed until the following day if the patient becomes symptomatic at night. We propose that CT evaluation, used in combination with UGI, may increase the overall sensitivity of detecting a leak, thereby improving patient outcomes and decreasing hospital utilization.
为了推进经口进食和康复进程，肥胖症手术患者通常会接受术后透视检查以排查包括渗漏在内的并发症。作为最严重且可能危及生命的并发症之一，肥胖症手术患者中高达5%会发生渗漏。这些患者的一些特征使得渗漏的检测变得复杂，包括体型庞大和行动不便。渗漏的早期检测可显著降低肥胖症手术患者的发病率和死亡率。在一项对619例患者的回顾性病例系列研究中，其中20例发生了渗漏，CT扫描的敏感性为95%，特异性为100%，而上消化道（UGI）评估的敏感性较低，为79%，特异性为95%。除了更高的敏感性和特异性外，CT扫描还可识别其他并发症，如脓肿和肠梗阻。此外，UGI评估明显更依赖患者和技术人员的配合，导致检查效果欠佳。另一方面，UGI可能有助于进一步确定渗漏的大小和更精确的位置，但如果患者在夜间出现症状，通常要到第二天才能进行UGI检查。我们建议，将CT评估与UGI联合使用，可能会提高检测渗漏的总体敏感性，从而改善患者预后并减少医院资源的利用。
