结直肠漏评分系统在左半结直肠癌切除术后吻合口漏预测中的应用价值  

Clinical Value of Colon Leakage Score System in Predicting Anastomotic Leakage after Left-Sided Colorectal Cancer Surgery

作　　者：李良[1] 杨仁保[1] 江鸣[1] 张军[1] 

机构地区：[1]合肥市第二人民医院普外科,安徽合肥230001

出　　处：《中国普外基础与临床杂志》2016年第11期1370-1374,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的 评估结直肠漏评分（CLS）系统预测左半结直肠癌切除术后吻合口漏的临床应用价值。方法回顾性分析我院2010年1月至2014年12月期间收治的310例行结直肠癌根治术并Ⅰ期吻合患者的临床资料,通过单因素分析术后吻合口漏发生的危险因素。应用受试者操作特征（ROC）曲线分析CLS系统预测左半结直肠癌患者术后吻合口漏发生的灵敏度和特异度。结果 310例患者中,有14例（4.5%）术后发生了吻合口漏。发生吻合口漏患者的CLS为（14.21±5.76）分,296例未发生吻合口漏患者的CLS为（4.43±3.36）分,前者明显高于后者,差异有统计学意义（t=9.474,P=0.000）。ROC曲线分析得出CLS系统预测吻合口漏的灵敏度为92.9%,特异度为88.6%,AUC为0.957（95%CI为0.924～0.991）,最佳诊断值为10（约登指数为0.867）。单因素分析结果显示,吻合口漏的发生率与左半结直肠癌患者的年龄、术前血红蛋白水平、肠梗阻状态及失血量有关（P〈0.05）。结论 CLS系统对左半结直肠癌切除术后吻合口漏的发生有较好的临床预测价值,但仍需要大样本、多中心、前瞻性的随机对照研究来验证CLS系统的临床应用价值。Objective To evaluate clinical value of colon leakage score （CLS）, a preoperative predictive scoring system, for risk of anastomotic leakage after left-sided colorectal cancer surgery. Methods The clinical data of 310 patients who underwent left-sided colorectal cancer surgery from January 2010 to December 2014 were studied retrospectively. Risk factors for postoperative anastomotic leakage were analyzed by univariate analysis. The sensitivity and specificity of CLS system were determined by receiver operating characteristic （ROC） curve analysis. Results a total of 14 patients were diagnosed as anastomotic leakage. The point of CLS for the patients with anastomotic leakage was significantly higher than that for the patients without anastomotic leakage （14.21±5.76 versus 4.43±3.36, t=9.474, P=0.000）. The results of ROC curve analysis showed that the sensitivity and specificity of the CLS system were 92.9% and 88.6%, respectively. The area under the curve was 0.957 （95% CI 0.92±0.991）. The best cut offvalue of CLS was 10 （The Youden index was 0.867）. The results of univariate analysis showed that the age, preoperative hemoglobin level, status of intestinal obstruction, and blood loss were associated with postoperative anastomotic leakage （P〈0.05）. Conclusions The preoperative predictive score system CLS could accurately predict occurrence of anastomotic leakage. While large, multicenter prospective randomized controlled trial is still needed to further confirm it.

关 键 词：结直肠癌切除术 吻合口漏 结直肠漏评分系统 预测价值 

分 类 号：R735.34[医药卫生—肿瘤]