腹腔镜Dixon直肠癌术后动态监测腹腔引流液中降钙素原、CRP水平对吻合口瘘的预测价值  

Predictive value of PCT and CRP in peritoneal drainage fluid for postoperative anastomotic leakage after laparoscopic Dixon radical resection of rectal cancer

作　　者：姚奇 何兰珍[4] 刘贤明 周家铭[4] 吕文 Yao Qi;He Lanzhen;Liu Xianming;Zhou Jiaming;Lyu Wen(Anorectal Surgery,Shenzhen People’s Hospital,Shenzhen 518020,China)

机构地区：[1]深圳市人民医院肛肠外科,深圳518020 [2]深圳市人民医院胃肠外科,深圳518020 [3]深圳市人民医院急诊科,深圳518020 [4]中山大学附属第六医院结直肠外科,广州510600

出　　处：《新医学》2019年第11期850-854,共5页Journal of New Medicine

摘　　要：目的探讨腹腔引流液中降钙素原和CRP水平对判断腹腔镜Dixon直肠癌根治术后患者发生吻合口瘘的预测价值。方法收集80例接受腹腔镜Dixon直肠癌根治术的患者临床资料,记录术后吻合口瘘发生情况。根据是否发生吻合口瘘分为观察组(有吻合口瘘)和对照组(无吻合口瘘),分别于术后当日、术后第3日及第5日检测并比较两组患者腹腔引流液中降钙素原和CRP水平,并绘制受试者工作特征(ROC)曲线评估腹腔引流液中降钙素原和CRP水平对预测术后吻合口瘘的价值。结果接受腹腔镜Dixon直肠癌根治术的80例患者中,发生吻合口瘘5例(6%),该5例纳入观察组,余75例未发生吻合口瘘者纳入对照组。观察组术后肛门排气时间和术后住院时间均较对照组延长(P均<0.05)。术后第3日和第5日观察组患者腹腔引流液中降钙素原和CRP水平均高于对照组(P均<0.05)。ROC分析结果显示,术后第3日腹腔引流液中降钙素原水平和术后第5日CRP水平对预测吻合口瘘具有较高的准确性,其对应的AUC最大,分别为0.845(与术后当日及术后第5日比较P均<0.05)、0.855(与术后当日及术后第3日比较P均<0.05),灵敏度分别为0.835、0.875,特异度分别为0.762、0.773。结论Dixon直肠癌根治术后动态监测腹腔引流液中降钙素原和CRP水平,尤其是监测术后第3日时的降钙素原水平和术后第5日时CRP水平对预测吻合口瘘具有较高价值。Objective To investigate the predictive value of procalcitonin(PCT)and C-reactive protein(CRP)in the peritoneal drainage fluid for postoperative anastomotic leakage after laparoscopic Dixon radical resection of rectal cancer(Dixon).Methods Clinical data of 80 patients undergoing laparoscopic Dixon radical resection of rectal cancer were retrospectively analyzed.The incidence of postoperative anastomotic leakage was recorded.All patients were divided into the observation group(with peritoneal drainage fluid)and the control group(without peritoneal drainage fluid)according to the incidence of postoperative anastomotic leakage.The levels of PCT and CRP at postoperative 1,3 and 5 d were detected and compared between two groups.The predictive values of PCT and CRP in the peritoneal drainage fluid for anastomotic leakage were evaluated by using the receiver operating characteristic(ROC)curve.Results Among 80 patients undergoing laparoscopic Dixon radical resection of rectal cancer,5 cases(6%)presenting with anastomotic leakage were enrolled in the observation group,and the remaining 75 cases without anastomotic leakage were assigned into the control group.Postoperative anal exhaust time and the length of postoperative hospital stay in the observation group were significantly longer than those in the control group(both P<0.05).In the observation group,the levels of PCT and CRP in the peritoneal abdominal drainage fluid at postoperative 3 and 5 d were significantly higher compared with those in the control group(all P<0.05).The ROC analysis demonstrated that the PCT level in the peritoneal abdominal drainage fluid at postoperative 3 d and the CRP level at postoperative 5 d yielded relatively high accuracy in predicting postoperative anastomotic leakage(AUC=0.845,0.855;both P<0.05;sensitivity=0.835,0.875;specificity=0.762,0.773,respectively).Conclusions Dynamic monitoring of PCT and CRP levels in the peritoneal drainage fluid after Dixon radical resection of rectal cancer,especially the CRP level at postoperative 3 d and

关 键 词：腹腔引流液 降钙素原 C反应蛋白 吻合口瘘 直肠癌 

分 类 号：R73[医药卫生—肿瘤]