Department of Surgery, Flevoziekenhuis, Almere, The Netherlands.
Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Colorectal Dis. 2021 Sep;23(9):2466-2471. doi: 10.1111/codi.15764. Epub 2021 Jun 29.
Computed tomography (CT) is currently the diagnostic tool most often used to detect anastomotic leakage (AL) after colorectal surgery. The aim of this study was to investigate the value of rectal contrast.
All patients who underwent colorectal surgery with a primary anastomosis between 2009 and 2018 were identified from a prospectively maintained database. Patients who underwent postoperative CT scanning in suspicion of AL were included. The clinical and radiological outcomes of patients with and without rectal contrast were compared.
A total of 1183 patient records were reviewed; 225 patients underwent CT-abdomen in suspicion of AL. Of these patients, 175 (77.8%) received rectal contrast. Sensitivity and specificity in this group were 78% and 94%, respectively. The positive predictive value (PPV) was 0.78 and the negative predictive value (NPV) was 0.94. In the group without rectal contrast (n = 50), sensitivity was 47%, specificity 88%, PPV 0.66 and NPV 0.76. In patients who received rectal contrast, contrast reached the anastomosis in 81.7% compared with 26.0% in patients who were given only oral contrast (p < 0.001). The sensitivity increased to 93% in the group of patients with contrast at the anastomosis, the specificity to 97%, the PPV to 0.88 and the NPV to 0.98. No adverse events were observed after the use of rectal contrast.
The use of rectal contrast led to a significant increase in the predictive value of CT scanning for AL, especially when it reached the anastomosis. This suggests that rectal contrast is a safe and useful adjunct to CT-abdomen in the detection of AL.
计算机断层扫描（CT）目前是诊断结直肠手术后吻合口漏（AL）最常用的工具。本研究旨在探讨直肠对比剂的价值。
从一个前瞻性维护的数据库中确定了 2009 年至 2018 年间接受原发性吻合术的所有结直肠手术患者。将术后怀疑 AL 而行 CT 扫描的患者纳入研究。比较有和无直肠对比剂的患者的临床和影像学结果。
共回顾了 1183 例患者的记录，225 例患者因怀疑 AL 而行 CT 腹部扫描。其中 175 例（77.8%）患者接受了直肠对比剂。该组的敏感性和特异性分别为 78%和 94%。阳性预测值（PPV）为 0.78，阴性预测值（NPV）为 0.94。在没有直肠对比剂的组（n=50）中，敏感性为 47%，特异性为 88%，PPV 为 0.66，NPV 为 0.76。在接受直肠对比剂的患者中，对比剂到达吻合口的比例为 81.7%，而仅接受口服对比剂的患者为 26.0%（p<0.001）。吻合口有对比剂的患者敏感性增加到 93%，特异性增加到 97%，PPV 增加到 0.88，NPV 增加到 0.98。使用直肠对比剂后未观察到不良事件。
直肠对比剂的使用显著提高了 CT 扫描对 AL 的预测价值，尤其是当对比剂到达吻合口时。这表明直肠对比剂是 CT 腹部扫描检测 AL 的一种安全有效的辅助手段。
