术后血磷浓度早期预测直肠癌术后吻合口瘘的价值研究  

Lower phosphate levels following sphincter-preserving surgery for rectal cancer is associated with postoperative anastomotic leakage

作　　者：周波[1] 鲁明典[1] 邓跃华[1] 曹先东[1] 常家聪[1] ZHOU Bo;LU Ming-dian;DENG Yue-hua;CAO Xian-dong;CHANG Jia-cong(Department of General Surgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui,China)

机构地区：[1]安徽医科大学第一附属医院普外科,安徽合肥230022

出　　处：《肠外与肠内营养》2020年第3期143-146,151,共5页Parenteral & Enteral Nutrition

基　　金：国家自然科学基金(81801952);安徽省自然科学基金(1708085QH199)。

摘　　要：目的:探讨术后血清磷浓度在早期预测直肠癌术后吻合口瘘中的价值。方法:回顾性分析直肠癌病人行直肠前切除术390例,根据术后30 d吻合口瘘是否发生分为吻合口瘘组和无吻合口瘘组,收集临床病理资料和术前术后血清磷浓度,采用混合线性模型比较两组术后10 d血清磷浓度之间的差异,并应用受试者工作特征曲线(ROC曲线)和Logistic多因素分析评估血清磷浓度早期预测直肠癌术后吻合口瘘的价值。结果:吻合口瘘组和无吻合口瘘组血磷浓度之间差异有统计学意义(P<0.05)。在术后第1天和术后第2天,吻合口瘘组血磷浓度明显低于无吻合口瘘组,差异有显著统计学意义(P<0.01)。术后第2天血磷浓度诊断直肠癌术后吻合口瘘的ROC曲线下面积为0.806,当血磷浓度为0.685 mmol/L时,敏感度及特异度最高,分别为87.2%和71.2%。术后第2天血清磷浓度(P<0.01)和肿瘤距肛缘距离(P<0.05)是直肠癌术后吻合口瘘的独立危险因素。结论:术后第2天血清磷浓度可以早期预测直肠癌术后吻合口瘘的发生。Objective:To evaluate the relationship between postoperative hypophosphatemia and postoperative anastomotic leakage after sphincter-preserving surgery for rectal cancer.Methods:A total of 390 consecutive patients with rectal cancer who underwent sphincter-preserving surgery were retrospectively analyzed.Perioperative serum phosphate levels and clinicopathological factors were collected and compared among patients who did and did not develop anastomotic leakage using chi-square test or mixed linear model approaches.ROC and multivariable analysis were performed to evaluate the diagnostic accuracy of postoperative serum phosphate levels for early diagnosis of anastomotic leakage.Results:Postoperative phosphate levels were significantly differed between the patients who developed leakage and those who did not(P<0.05).The serum phosphate levels on postoperative day(POD)1 and 2 in patients who developed leakage were lower than those who did not(P<0.01).The area under the curve on POD 2 was 0.806(95%CI,0.666-0.821).The sensitivity and specificity were 87.2%and 71.2%respectively.POD 2 phosphate concentrations(P<0.01)and tumor distance from anal verge(P<0.05)were independently associated with anastomotic leakage after sphincter-preserving surgery for rectal cancer.Conclusion:Lower phosphate levels in the early postoperative period following sphincter-preserving surgery for rectal cancer are associated with increased risk of anastomotic leakage.

关 键 词：直肠癌 直肠前切除术 血清磷浓度 吻合口瘘 预测 

分 类 号：R735.37[医药卫生—肿瘤]