血浆降钙素原对结直肠癌术后肠梗阻中的预测作用  

Plasma procalcitonin levels for prediction of postoperative ileus following colorectal cancer surgery

作　　者：朱鹏程[1] 梁中林[1] 王光辉[1] 崔龙[1] 

机构地区：[1]上海交通大学医学院附属新华医院肛肠外科,上海200092

出　　处：《中国普通外科杂志》2013年第10期1319-1323,共5页China Journal of General Surgery

基　　金：上海市科委基础研究重点资助项目(10DJ1400504)

摘　　要：目的：探讨结直肠癌手术后患者血浆中细胞因子水平的变化与术后肠梗阻的关系。方法：选择100例行乙状结肠癌或直肠癌根治术的患者，在术后第1，3，5天抽取患者的静脉血，检测降钙素原（PCT），C反应蛋白（CRP）和肿瘤坏死因子α（TNF-α）水平。根据患者术后是否发生肠梗阻，将患者分为肠梗阻组与非肠梗阻组，比较两组术前、术中、术后情况，以及术后上述细胞因子的水平。结果：8位患者在术后第10～15天出现肠梗阻。肠梗阻组的首次排气时间明显长于非肠梗阻组（P〈0．05），其他临床变量如年龄、性别、体质量指数、肿瘤部位、术中出血量、手术时间、术后住院时间两组间差异均无统计学意义（均P〉0．05）；两组术后第1，3天PCT水平无统计学差异（均P〉0．05），但肠梗阻组术后第5天PCT水平明显升高，与非肠梗阻组比较差异有统计学意义（P=0．014）；两组术后CRP和TNF-α水平变化趋势基本一致，各时间点差异均无统计学意义（均P〉0．05）。结论：结直肠癌术后患者血浆中PCT水平的升高可能是1项早期预测术后肠梗阻的实验室指标。Objective： To investigate the relationship between changes of the plasma cytokine levels and the occurrence of postoperative ileus in patients after radical resection for colorectal cancer. Methods： One hundred consecutive patients undergoing radical resection for sigmoid or rectal cancer were selected. Venous blood samples were drawn from the patients on postoperative day （POD） 1, 3 and S formeasurement of the plasma levels of procalcitonin （PCT）, C-reactive protein （CRP） and tumor necrosis α （TNF-α）. The sub）ects were divided into ileus group and non-ileus group according to whether an ileus was present, and the pre-, intra- and postoperative conditions, as well as the levels of above cytokines were compared between the two groups. Results： Ileus occurred in 8 of the patients on POD 10 to 15. The time to first flatus passage in ileus group was significantly longer than that in non-ileus group, but other variables that included age, sex, body mass index, tumor site, intraoperative blood loss, operative time and length of postoperative hospital stay showed no significant difference between the two groups （all P〉0.05）. The PCT levels on POD 1 and 3 were not significantly different between the two groups （P〉0.05）, but it was remarkably increased on POD 5 in ileus group and the difference reached significant significance versus non-ileus group （P=0.014）. She changes of postoperative CRP and TNF-ct level in the two groups showed a similar tendency, and the differences between the two groups at each time point had no statistical significance （all P〉0.05）. Conclusion： Increased plasma PCT level may be a laboratory indicator for early prediction of the occurrence of postoperative ileus following colorectal carcinoma surgery.

关 键 词：结直肠肿瘤 外科学 肠梗阻 手术后并发症 预防与控制 细胞因子类 

分 类 号：R735.3[医药卫生—肿瘤]