Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy.
Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy.
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DOI：
10.5090/kjtcs.2016.49.2.99
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发表时间：
2016-04
期刊：
影响因子：
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通讯作者：
Parekh KR
中科院分区：
文献类型：
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作者：
Roh S;Iannettoni MD;Keech JC;Bashir M;Gruber PJ;Parekh KR
食管切除术后进行吞钡检查，以评价吻合口是否存在渗漏，并评估胃管排空情况。本研究的目的是评价吞钡研究在诊断食管切除术后吻合口瘘中的可靠性。对2000年1月至2013年12月在我们机构接受食管切除术的患者进行了研究。在第5-7天之间常规进行吞钡检查以检测泄漏。将这些结果与术后期间临床确定的渗漏（定义为需要空肠喂养和/或肠外营养的颈部伤口感染）进行比较。测定了吞钡诊断临床显著吻合口漏的敏感性和特异性。共进行了395例食管切除术（平均年龄62.2岁）。食管切除术的适应症如下：恶性肿瘤（n=320）、高度异型增生（n=14）、穿孔（n=27）、良性狭窄（n=7）、贲门失弛缓症（n=16）和其他（n=11）。使用了各种技术，包括经裂孔（n=351）、McKeown（n=35）和Ivor刘易斯（n=9）食管切除术。手术死亡率为2.8%（n=11）。368例患者（93%）在食管切除术后接受了钡剂吞咽研究。在36例患者（9.8%）中确定了具有临床意义的吻合口瘘。钡剂吞咽仅能够检测到13/36例具有临床意义的泄漏。吞咽诊断渗漏的敏感性为36%，特异性为97%。钡剂吞入法检测漏的阳性预测值为59%，阴性预测值为93%。吞钡是一种不敏感但特异性强的检测食管切除术后颈部吻合口渗漏的方法。
Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy. Patients who underwent esophagectomy from January 2000 to December 2013 at our institution were investigated. Barium swallow was routinely done between days 5–7 to detect a leak. These results were compared to clinically determined leaks (defined by neck wound infection requiring jejunal feeds and or parenteral nutrition) during the postoperative period. The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was determined. A total of 395 esophagectomies were performed (mean age, 62.2 years). The indications for the esophagectomy were as follows: malignancy (n=320), high-grade dysplasia (n=14), perforation (n=27), benign stricture (n=7), achalasia (n=16), and other (n=11). A variety of techniques were used including transhiatal (n=351), McKeown (n=35), and Ivor Lewis (n=9) esophagectomies. Operative mortality was 2.8% (n=11). Three hundred and sixty-eight patients (93%) underwent barium swallow study after esophagectomy. Clinically significant anastomotic leak was identified in 36 patients (9.8%). Barium swallow was able to detect only 13/36 clinically significant leaks. The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.