超声造影剂灌肠造影对直肠癌术后吻合口漏的诊断价值

Diagnostic value of ultrasound contrast agent enema in patients with anastomotic leakage after rectal cancer resection

目的探讨超声造影剂灌肠造影(UCAE)对直肠癌术后吻合口漏(AL)的诊断价值。方法回顾性分析中山大学附属第六医院2020年1月至2022年12月直肠癌术后因骶前积液行经会阴灰阶超声(PNUS)和UCAE的患者95例, 其中70例(73.3%)患者确诊AL。所有患者经PNUS扫查后, 经直肠腔内灌注稀释超声造影剂进行UCAE检查。使用ROC曲线比较PNUS、UCAE、CT、MRI及泛影葡胺灌肠造影对AL诊断的准确性, 并分析UCAE诊断敏感性的影响因素。结果不同医师使用UCAE诊断AL的一致性明显高于PNUS(Kappa值0.757比0.292, P<0.001), 其诊断准确性明显优于PNUS[曲线下面积(AUC) 0.893比0.693, P<0.001], 并与CT(AUC 0.807)、MRI(AUC 0.811)、泛影葡胺灌肠造影(AUC 0.923)差异无统计学意义(均P>0.05)。对中高位AL(吻合口距离肛缘≥70 mm)及微小AL(≤3 mm), UCAE的敏感性明显下降(吻合口位置25.0%比85.5%, P=0.001;吻合口大小42.9%比87.5%, P=0.002)。结论 UCAE明显提高了PNUS对直肠癌术后AL的诊断准确性和一致性, 其诊断敏感性受吻合口距肛缘距离及漏口直径影响。

Objective To investigate the diagnostic value of ultrasound contrast agent enema(UCAE)for anastomotic leakage(AL)after rectal cancer surgery.Methods From January 2020 to December 2022,a total of 95 patients with presacral fluid collection after rectal cancer surgery in the Sixth Affiliated Hospital of Sun Yat-sen University who received perineal ultrasound(PNUS)and UCAE were retrospectively selected.Among them,70 patients(73.3%)were diagnosed with AL.After PNUS scanning,all patients received a diluted ultrasound contrast agent administered through the rectum.Receiver operating characteristic(ROC)curve were used to compare the accuracies of PNUS,UCAE,CT,MRI and water-soluble contrast enema in the diagnosis of AL.Factors that may have impacts on the sensitivity of UCAE were thoroughly analyzed.Results UCAE improved the consistency(Kappa value:0.757 vs 0.292,P<0.001)and accuracy(AUC:0.893 vs 0.693,P<0.001)of PNUS in the diagnosis of AL,and its diagnostic accuracy was comparable to that of CT(AUC 0.807),MRI(AUC 0.811)and water-soluble contrast enema(AUC 0.923)(all P>0.05).For mid-to-high AL(anastomotic stoma distance≥70 mm)and tiny AL(≤3 mm),the sensitivity of UCAE decreased significantly(anastomotic stoma position:25.0%vs 85.5%,P=0.001;anastomotic leak diameter:42.9%vs 87.5%,P=0.002).Conclusions UCAE can significantly improve the diagnostic accuracy and consistency of PNUS for AL after rectal cancer surgery,and its diagnostic sensitivity is affected by the anastomotic stoma distance and the diameter of the leak.