食管碘剂造影对食管癌术后胸内吻合口瘘的诊断价值  

The value of ionic-contrast esophagogram in diagnosis of intrathoracic anastomotic leakage after oesophagectomy

作　　者：廖志敏[1] 郑威[1] 黄维江[1] 胡磊[1] 庞一雄[1] Liao Zhimin Zheng Wei Huang Weijiang Hu Lei Pang Yixiong(Department of Cardiothoracic Surgery,Xiaogan Central Hospital,Xiaogan, Hubei 432100, China)

机构地区：[1]孝感市中心医院胸心外科,湖北省孝感432100

出　　处：《中国基层医药》2017年第13期1985-1988,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 探讨食管碘剂造影在诊断食管癌术后胸内吻合口瘘中的价值.方法 回顾性分析行食管癌手术胸内吻合患者728例的临床资料,将无吻合口瘘临床表现的723例患者依据进食前是否进行食管造影检查分为进食前造影组（A组,n=465）、进食前未造影组（B组,n=258）,比较两组吻合口瘘的发生率.结果 A、B两组吻合口瘘发现率分别为0.43%（2/465）、0.78%（2/258）,两组差异无统计学意义（P=0.55）;A、B两组吻合口瘘发生率分别为0.65%（3/465）、0.78%（2/258）,两组差异无统计学意义（P=0.84）.5例临床疑似吻合口瘘的患者,均有包裹性胸腔积液,4例有发热,2例有异常的胸管引流,最终4例造影证实为吻合口瘘.结论 食管癌术后,进食前常规进行食管造影检查并不能提高胸内吻合口瘘发现率,但对有发热、包裹性胸腔积液、胸管引流液性状异常等提示吻合口瘘的患者进行食管造影检查可提高吻合口瘘发现率.CT造影检查较常规造影检查可能发现更小的吻合口瘘.Objective To investigate the value of ionic-contrast esophagogram in diagnosis of intrathoracic anastomotic leakage after oesophagectomy.Methods The data of 728 patients suffered esophagectomy were retrospectively collected.723 patients without clinical manifestations of anastomotic leakage were divided into group A（esophagogram before eating,n=465） and group B（non-esophagogram before eating,n=258）.The incidence of anastomotic leakage was compared between the two groups.Results The discovery rates of anastomotic leakage in group A and B were 0.43%（2/465） and 0.78%（2/258）,respectively,the difference was no statistically significant between the two group（P=0.55）.The total incidence rates of anastomotic leakage in group A and B were 0.65%（3/465） and 0.78%（2/258）,respectively,the difference was no statistically significant between the two groups（P=0.84）.5 patients with clinically suspected anastomotic leakage,all had loculated pleural effusion,4 cases had fever,and 2 cases had abnormal chest drainage.Finally,4 cases（80%） were confirmed to be anastomotic leak by esophagogram.Conclusion Routine ionic-contrast esophagogram before eating do not improve intrathoracic anastomotic leakage detection rate after esophagectomy,but when patients have fever,loculated pleural effusion and abnormal chest drainage,esophagogram is necessary and can improve the detection rate of esophageal anastomotic leak.CT radiography may detect smaller anastomotic leakage than conventional esophagogram.

关 键 词：食管肿瘤 吻合口瘘 食管造影 体层摄影术 X线计算机 

分 类 号：R735.1[医药卫生—肿瘤]