术中组织氧饱和度对结肠癌病人术后吻合口愈合预测价值  

Value of intraoperative tissue oxygen saturation in predicting anastomotic healing in patients with colon cancer

作　　者：梁林虎 韩婷 张峥嵘 李浩然 程正武 茆家定 LIANG Linhu;HAN Ting;ZHANG Zhengrong;LI Haoran;CHENG Zhengwu;MAO Jiading(Department of Gastrointestinal Surgery,The First Affiliated Hospital of Wannan Medical College,Wuhu Anhui 241000,China)

机构地区：[1]皖南医学院第一附属医院胃肠外科,安徽芜湖241000

出　　处：《蚌埠医学院学报》2024年第9期1136-1140,共5页Journal of Bengbu Medical College

基　　金：安徽省高校自然科学研究重大项目(KJ2021ZD0095)。

摘　　要：目的:探讨术中组织氧饱和度(StO_(2))用于结肠癌病人术后吻合口愈合情况预测的价值。方法:选取结肠癌病人100例作为研究对象,均予以根治性结肠切除术。术中采用吲哚菁绿(ICG)荧光显像技术辅助吻合手术,同时监测不同部位StO_(2),采用Pearson相关分析组织StO_(2)水平与横断部位距离的相关性。术后30 d观察吻合口愈合情况并根据愈合与否分为吻合口瘘(AL)组和非AL组,采用多因素logistic分析筛选术后吻合口愈合的影响因素,绘制ROC曲线评价术中StO_(2)对结肠癌病人术后吻合口愈合情况的预测价值。结果:术后30 d,4例发生AL归为AL组,AL发生率为4.00%,均经抗生素、引流治疗后愈合,其余96例归为非AL组。StO_(2)测量以2 cm的间隔进行,沿荧光灌注结束的点的位置绘制6个点。位置0表示荧光灌注结束的点(横断部位),并且位置5表示横断部位远端(10 cm),相关性分析显示,StO_(2)水平随离横断部位距离增加而降低(r=0.908,P<0.01)。AL组糖尿病、术前新辅助治疗占比较非AL组高,横断部位(0点)测得StO_(2)水平较非AL组低(P<0.05)。多因素logistic回归分析,横断部位(0点)StO_(2)(OR=0.622,95%CI:0.392~0.988)为结肠癌术后吻合口愈合的保护因素(P<0.05);ROC曲线显示,术中StO_(2)预测结肠癌术后吻合口愈合的AUC为0.833(95%CI:0.746~0.900),特异性为97.92%,灵敏度为75.00%,最佳截断值为0.56。结论:术中StO_(2)可评价结肠癌病人吻合口血运情况,对术后吻合口愈合具有一定预测价值。Objective:To explore the value of intraoperative tissue oxygen saturation(StO_(2))in predicting postoperative anastomotic healing in patients with colon cancer.Methods:A total of 100 patients with colon cancer were selected as the study subjects,and all of them were subjected to radical colectomy.Indocyanine green(ICG)fluorescence imaging technique was used to assist the anastomosis during the operation,and StO_(2)in different parts was monitored at the same time.Pearson correlation analysis was used to analyze the correlation between StO_(2)level in tissue and the distance from the transverse part.The anastomotic healing was observed 30 days after operation and divided into anastomotic leakage(AL)group and non-AL group according to whether it healed or not.The influencing factors of postoperative anastomotic healing were screened by multivariate logistic analysis,and the ROC curve was drawn to evaluate the predictive value of StO_(2)during operation for postoperative anastomotic healing of colon cancer patients.Results:At 30 days after surgery,4 cases of AL were classified into AL group,the incidence of AL was 4.00%,all of which healed after antibiotic and drainage treatment,and the other 96 cases were classified into non-AL group.StO_(2)measurements were performed at 2 cm intervals,with 6 points plotted along the location of the point where the fluorescence perfusion ended.Position 0 represented the end point of fluorescence perfusion(the transverse site),and position 5 represented the distal end of the transverse site(10 cm).Correlation analysis showed that StO_(2)levels decreased with increasing distance from the transverse site(r=0.908,P<0.01).Compared with non-AL group,the proportion of diabetes mellitus and preoperative neoadjuvant therapy in AL group was higher,and the StO_(2)level at the transverse site(0 point)was lower than that in non-AL group(P<0.05).Multivariate Logistic regression analysis showed that StO_(2)(OR=0.622,95%CI:0.392-0.988)at the cross-sectional site was a protective factor for anastom

关 键 词：结肠肿瘤 组织氧饱和度 吻合口瘘 

分 类 号：R735.35[医药卫生—肿瘤]