ISSN: 1859 - 2872
Giá trị của chụp cắt lớp vi tính bơm thuốc cản quang trực tràng trong chẩn đoán rò miệng nối đại trực tràng sau phẫu thuật ung thư
Main Article Content
Keywords
Chụp cắt lớp vi tính, thuốc cản quang đường trực tràng, rò miệng nối đại trực tràng.
Tóm tắt
Mục tiêu: Xác định giá trị của chụp cắt lớp vi tính (CLVT) có bơm thuốc cản quang trực tràng trong chẩn đoán rò miệng nối ĐTT sau phẫu thuật điều trị ung thư. Đối tượng và phương pháp: Nghiên cứu mô tả cắt ngang, hồi cứu trên 80 bệnh nhân được chẩn đoán lâm sàng nghi ngờ rò miệng nối ĐTT sau phẫu thuật điều trị ung thư, có chụp CLVT bơm thuốc cản quang trực tràng và được phẫu thuật lại. Các dấu hiệu CLVT được đối chiếu với kết quả phẫu thuật để đánh giá giá trị chẩn đoán. Kết quả: Tuổi trung bình của bệnh nhân là 58,1 ± 16,2, nam chiếm 60,0%. Sự vắng mặt của khí tự do trong ổ bụng là dấu hiệu có giá trị loại trừ rò cao nhất (LR- = 0,10; KTC 95%: 0,04 - 0,26). Khí tự do quanh miệng nối là dấu hiệu có giá trị khẳng định rò cao nhất (LR+ = 8,29; KTC 95%: 1,29 - 53,36). CLVT có bơm thuốc cản quang trực tràng có độ nhạy 92,9%, độ đặc hiệu 70,0%, giá trị tiên đoán dương 95,6% và giá trị tiên đoán âm 58,3% (LR+ = 3,10; LR- = 0,10). Kết luận: CLVT có bơm thuốc cản quang trực tràng là phương tiện hữu ích trong chẩn đoán rò miệng nối ĐTT sau phẫu thuật ung thư, đặc biệt ở các trường hợp còn nghi ngờ lâm sàng. Tuy nhiên, kết quả âm tính không loại trừ hoàn toàn rò miệng nối và cần được diễn giải kết hợp với lâm sàng.
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Các tài liệu tham khảo
1. Slieker JC, Komen N, Mannaerts GH et al (2012) Long-term and perioperative corticosteroids in anastomotic leakage: A prospective study of 259 left-sided colorectal anastomoses. Arch Surg 147(5): 447-452. doi:10.1001/archsurg.2011.1690
2. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3): 339-351. doi:10.1016/j.surg.2009.10.012
3. Notash AY, Sadeghian E, Moghimi Z, Rahimi Y, Sobhanian E (2025) Diagnostic value of CT scan findings for anastomotic leakage after low anterior resection without ileostomy in rectal cancer. Sci Rep 15(1): 20950. doi:10.1038/s41598-025-06712-4
4. Kornmann VN, Treskes N, Hoonhout LH, Bollen TL, van Ramshorst B, Boerma D (2013) Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis 28(4): 437-445. doi:10.1007/s00384-012-1623-3
5. Peters EG, Dekkers M, van Leeuwen-Hilbers FW et al (2017) Relation between postoperative ileus and anastomotic leakage after colorectal resection: A post hoc analysis of a prospective randomized controlled trial. Colorectal Dis 19(7): 667-674. doi:10.1111/codi.13582
6. Dương Đình Hoàn, Võ Tấn Đức, Lê Văn Phước (2022) Describing the features of computed tomography in diagnosing anastomotic leak. Vietnamese Journal of Radiology and Nuclear Medicine 32: 16-21. doi:10.55046/vjrnm.32.533.2018
7. Power N, Atri M, Ryan S, Haddad R, Smith A (2007) CT assessment of anastomotic bowel leak. Clin Radiol 62(1): 37-42. doi:10.1016/j.crad.2006.08.004
8. Gervaz P, Platon A, Buchs NC, Rocher T, Perneger T, Poletti PA (2013) CT scan-based modelling of anastomotic leak risk after colorectal surgery. Colorectal Dis 15(10): 1295-1300. doi:10.1111/codi.12305
9. Tsai YY, Chen WT (2019) Management of anastomotic leakage after rectal surgery: A review article. J Gastrointest Oncol 10(6): 1229-1237. doi:10.21037/jgo.2019.07.07
10. Marres CCM, Engelmann EWM, Buskens CJ, Haak HE, Bemelman WA, van de Ven AWH (2021) The importance of rectal contrast in CT assessment to detect anastomotic leakage after colorectal surgery. Colorectal Dis 23(9): 2466-2471. doi:10.1111/codi.15764
11. Samji KB, Kielar AZ, Connolly M et al (2018) Anastomotic leaks after small- and large-bowel surgery: Diagnostic performance of CT and the importance of intraluminal contrast administration. AJR Am J Roentgenol 210(6): 1259-1265. doi:10.2214/AJR.17.18642
12. Kornmann VN, van Ramshorst B, Smits AB, Bollen TL, Boerma D (2014) Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis 29(4): 445-451. doi:10.1007/s00384-013-1815-5
13. Gessler B, Eriksson O, Angenete E (2017) Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2017;32(4):549-556. doi:10.1007/s00384-016-2744-x
14. Moreno-Lopez N, Mvouama S, Bourredjem A, et al (2023) CT scan for early diagnosis of anastomotic leak after colorectal surgery: Is rectal contrast useful? Tech Coloproctol 27(8): 639-645. doi:10.1007/s10151-022-02716-8
1. Slieker JC, Komen N, Mannaerts GH et al (2012) Long-term and perioperative corticosteroids in anastomotic leakage: A prospective study of 259 left-sided colorectal anastomoses. Arch Surg 147(5): 447-452. doi:10.1001/archsurg.2011.1690
2. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3): 339-351. doi:10.1016/j.surg.2009.10.012
3. Notash AY, Sadeghian E, Moghimi Z, Rahimi Y, Sobhanian E (2025) Diagnostic value of CT scan findings for anastomotic leakage after low anterior resection without ileostomy in rectal cancer. Sci Rep 15(1): 20950. doi:10.1038/s41598-025-06712-4
4. Kornmann VN, Treskes N, Hoonhout LH, Bollen TL, van Ramshorst B, Boerma D (2013) Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis 28(4): 437-445. doi:10.1007/s00384-012-1623-3
5. Peters EG, Dekkers M, van Leeuwen-Hilbers FW et al (2017) Relation between postoperative ileus and anastomotic leakage after colorectal resection: A post hoc analysis of a prospective randomized controlled trial. Colorectal Dis 19(7): 667-674. doi:10.1111/codi.13582
6. Dương Đình Hoàn, Võ Tấn Đức, Lê Văn Phước (2022) Describing the features of computed tomography in diagnosing anastomotic leak. Vietnamese Journal of Radiology and Nuclear Medicine 32: 16-21. doi:10.55046/vjrnm.32.533.2018
7. Power N, Atri M, Ryan S, Haddad R, Smith A (2007) CT assessment of anastomotic bowel leak. Clin Radiol 62(1): 37-42. doi:10.1016/j.crad.2006.08.004
8. Gervaz P, Platon A, Buchs NC, Rocher T, Perneger T, Poletti PA (2013) CT scan-based modelling of anastomotic leak risk after colorectal surgery. Colorectal Dis 15(10): 1295-1300. doi:10.1111/codi.12305
9. Tsai YY, Chen WT (2019) Management of anastomotic leakage after rectal surgery: A review article. J Gastrointest Oncol 10(6): 1229-1237. doi:10.21037/jgo.2019.07.07
10. Marres CCM, Engelmann EWM, Buskens CJ, Haak HE, Bemelman WA, van de Ven AWH (2021) The importance of rectal contrast in CT assessment to detect anastomotic leakage after colorectal surgery. Colorectal Dis 23(9): 2466-2471. doi:10.1111/codi.15764
11. Samji KB, Kielar AZ, Connolly M et al (2018) Anastomotic leaks after small- and large-bowel surgery: Diagnostic performance of CT and the importance of intraluminal contrast administration. AJR Am J Roentgenol 210(6): 1259-1265. doi:10.2214/AJR.17.18642
12. Kornmann VN, van Ramshorst B, Smits AB, Bollen TL, Boerma D (2014) Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis 29(4): 445-451. doi:10.1007/s00384-013-1815-5
13. Gessler B, Eriksson O, Angenete E (2017) Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2017;32(4):549-556. doi:10.1007/s00384-016-2744-x
14. Moreno-Lopez N, Mvouama S, Bourredjem A, et al (2023) CT scan for early diagnosis of anastomotic leak after colorectal surgery: Is rectal contrast useful? Tech Coloproctol 27(8): 639-645. doi:10.1007/s10151-022-02716-8
2. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3): 339-351. doi:10.1016/j.surg.2009.10.012
3. Notash AY, Sadeghian E, Moghimi Z, Rahimi Y, Sobhanian E (2025) Diagnostic value of CT scan findings for anastomotic leakage after low anterior resection without ileostomy in rectal cancer. Sci Rep 15(1): 20950. doi:10.1038/s41598-025-06712-4
4. Kornmann VN, Treskes N, Hoonhout LH, Bollen TL, van Ramshorst B, Boerma D (2013) Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis 28(4): 437-445. doi:10.1007/s00384-012-1623-3
5. Peters EG, Dekkers M, van Leeuwen-Hilbers FW et al (2017) Relation between postoperative ileus and anastomotic leakage after colorectal resection: A post hoc analysis of a prospective randomized controlled trial. Colorectal Dis 19(7): 667-674. doi:10.1111/codi.13582
6. Dương Đình Hoàn, Võ Tấn Đức, Lê Văn Phước (2022) Describing the features of computed tomography in diagnosing anastomotic leak. Vietnamese Journal of Radiology and Nuclear Medicine 32: 16-21. doi:10.55046/vjrnm.32.533.2018
7. Power N, Atri M, Ryan S, Haddad R, Smith A (2007) CT assessment of anastomotic bowel leak. Clin Radiol 62(1): 37-42. doi:10.1016/j.crad.2006.08.004
8. Gervaz P, Platon A, Buchs NC, Rocher T, Perneger T, Poletti PA (2013) CT scan-based modelling of anastomotic leak risk after colorectal surgery. Colorectal Dis 15(10): 1295-1300. doi:10.1111/codi.12305
9. Tsai YY, Chen WT (2019) Management of anastomotic leakage after rectal surgery: A review article. J Gastrointest Oncol 10(6): 1229-1237. doi:10.21037/jgo.2019.07.07
10. Marres CCM, Engelmann EWM, Buskens CJ, Haak HE, Bemelman WA, van de Ven AWH (2021) The importance of rectal contrast in CT assessment to detect anastomotic leakage after colorectal surgery. Colorectal Dis 23(9): 2466-2471. doi:10.1111/codi.15764
11. Samji KB, Kielar AZ, Connolly M et al (2018) Anastomotic leaks after small- and large-bowel surgery: Diagnostic performance of CT and the importance of intraluminal contrast administration. AJR Am J Roentgenol 210(6): 1259-1265. doi:10.2214/AJR.17.18642
12. Kornmann VN, van Ramshorst B, Smits AB, Bollen TL, Boerma D (2014) Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis 29(4): 445-451. doi:10.1007/s00384-013-1815-5
13. Gessler B, Eriksson O, Angenete E (2017) Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2017;32(4):549-556. doi:10.1007/s00384-016-2744-x
14. Moreno-Lopez N, Mvouama S, Bourredjem A, et al (2023) CT scan for early diagnosis of anastomotic leak after colorectal surgery: Is rectal contrast useful? Tech Coloproctol 27(8): 639-645. doi:10.1007/s10151-022-02716-8
1. Slieker JC, Komen N, Mannaerts GH et al (2012) Long-term and perioperative corticosteroids in anastomotic leakage: A prospective study of 259 left-sided colorectal anastomoses. Arch Surg 147(5): 447-452. doi:10.1001/archsurg.2011.1690
2. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3): 339-351. doi:10.1016/j.surg.2009.10.012
3. Notash AY, Sadeghian E, Moghimi Z, Rahimi Y, Sobhanian E (2025) Diagnostic value of CT scan findings for anastomotic leakage after low anterior resection without ileostomy in rectal cancer. Sci Rep 15(1): 20950. doi:10.1038/s41598-025-06712-4
4. Kornmann VN, Treskes N, Hoonhout LH, Bollen TL, van Ramshorst B, Boerma D (2013) Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis 28(4): 437-445. doi:10.1007/s00384-012-1623-3
5. Peters EG, Dekkers M, van Leeuwen-Hilbers FW et al (2017) Relation between postoperative ileus and anastomotic leakage after colorectal resection: A post hoc analysis of a prospective randomized controlled trial. Colorectal Dis 19(7): 667-674. doi:10.1111/codi.13582
6. Dương Đình Hoàn, Võ Tấn Đức, Lê Văn Phước (2022) Describing the features of computed tomography in diagnosing anastomotic leak. Vietnamese Journal of Radiology and Nuclear Medicine 32: 16-21. doi:10.55046/vjrnm.32.533.2018
7. Power N, Atri M, Ryan S, Haddad R, Smith A (2007) CT assessment of anastomotic bowel leak. Clin Radiol 62(1): 37-42. doi:10.1016/j.crad.2006.08.004
8. Gervaz P, Platon A, Buchs NC, Rocher T, Perneger T, Poletti PA (2013) CT scan-based modelling of anastomotic leak risk after colorectal surgery. Colorectal Dis 15(10): 1295-1300. doi:10.1111/codi.12305
9. Tsai YY, Chen WT (2019) Management of anastomotic leakage after rectal surgery: A review article. J Gastrointest Oncol 10(6): 1229-1237. doi:10.21037/jgo.2019.07.07
10. Marres CCM, Engelmann EWM, Buskens CJ, Haak HE, Bemelman WA, van de Ven AWH (2021) The importance of rectal contrast in CT assessment to detect anastomotic leakage after colorectal surgery. Colorectal Dis 23(9): 2466-2471. doi:10.1111/codi.15764
11. Samji KB, Kielar AZ, Connolly M et al (2018) Anastomotic leaks after small- and large-bowel surgery: Diagnostic performance of CT and the importance of intraluminal contrast administration. AJR Am J Roentgenol 210(6): 1259-1265. doi:10.2214/AJR.17.18642
12. Kornmann VN, van Ramshorst B, Smits AB, Bollen TL, Boerma D (2014) Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis 29(4): 445-451. doi:10.1007/s00384-013-1815-5
13. Gessler B, Eriksson O, Angenete E (2017) Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2017;32(4):549-556. doi:10.1007/s00384-016-2744-x
14. Moreno-Lopez N, Mvouama S, Bourredjem A, et al (2023) CT scan for early diagnosis of anastomotic leak after colorectal surgery: Is rectal contrast useful? Tech Coloproctol 27(8): 639-645. doi:10.1007/s10151-022-02716-8
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LiêmP. T., & TuấnH. X. (2026). Giá trị của chụp cắt lớp vi tính bơm thuốc cản quang trực tràng trong chẩn đoán rò miệng nối đại trực tràng sau phẫu thuật ung thư. Journal of 108 - Clinical Medicine and Phamarcy, 21(6). https://doi.org/10.52389/ydls.v21i6.3103