血清CRP在预测结直肠手术后早期吻合口漏的临床价值
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摘要
目的探讨术后血清C反应蛋白(C-reactive protein,CRP)相较于白细胞计数(white blood count,WBC)在早期诊断结直肠手术后吻合口漏的临床价值。方法选取2013年1月1日至2016年12月30日在东莞市横沥医院行结直肠手术的患者共80例,根据是否有吻合口漏分为两组,吻合口漏组20例和无吻合口漏组60例。连续检测两组患者术前和术后9天内的血清CRP和WBC,比较两组之间的差异。结果术后吻合口漏的诊断时间介于术后第3天至第10天(平均时间为术后第5天)。吻合口漏组平均住院时间较无吻合口漏组长(30.1天vs.10.4天,P<0.001)。术后第2天开始吻合口漏组患者的血清CRP平均水平明显高于无吻合口漏组患者(187.3 mg/L vs.137.0 mg/L,P<0.001)。术后第5天开始WBC在吻合口漏组明显高于无吻合口漏组(11.8×109/L vs.8.1×109/L,P<0.001)。结论结直肠癌手术后CRP早期呈持续性增高,提示可能发生吻合口漏。吻合口漏的患者术后CRP比WBC更早出现变化。
Objective To investigate the predictive value of postoperative serum C reactive protein(CRP) compared with white blood count(WBC) in the early diagnosis of anastomotic leakage after colorectal surgery. Methods From January 1, 2013 to December 30, 2016, 80 patients who underwent colorectal surgery in our hospital were divided into two groups according to whether anastomotic leakage occurred or not. Patients with anastomotic leakage(n =20) were compared with those without leakage(n =60). Serum levels of CRP and WBC were recorded and analyzed in both groups before operation and within nine days after operation. Results The diagnosis of anastomotic leakage was confirmed between the 3 rd and 10 th postoperative day(POD)(mean 5 th POD). The average length of stay in the leakage group was longer than that in the group without leakage(P<0.001). The daily average values of serum CRP in leakage group were significantly higher than those in non-leakage group starting at the 2 nd POD and remained significantly elevated until the confirmed diagnosis(P <0.001). However, Comparison of postoperative WBC values between the two groups until the 5 th POD did not show any significant difference(P <0.001). Conclusions An early and persistent elevation of serum CRP levels after colorectal surgery is suggestive of anastomotic leakage. Patients with anastomotic leakage can have early changes to CRP in advance WBC.
Objective To investigate the predictive value of postoperative serum C reactive protein(CRP) compared with white blood count(WBC) in the early diagnosis of anastomotic leakage after colorectal surgery. Methods From January 1, 2013 to December 30, 2016, 80 patients who underwent colorectal surgery in our hospital were divided into two groups according to whether anastomotic leakage occurred or not. Patients with anastomotic leakage(n =20) were compared with those without leakage(n =60). Serum levels of CRP and WBC were recorded and analyzed in both groups before operation and within nine days after operation. Results The diagnosis of anastomotic leakage was confirmed between the 3 rd and 10 th postoperative day(POD)(mean 5 th POD). The average length of stay in the leakage group was longer than that in the group without leakage(P<0.001). The daily average values of serum CRP in leakage group were significantly higher than those in non-leakage group starting at the 2 nd POD and remained significantly elevated until the confirmed diagnosis(P <0.001). However, Comparison of postoperative WBC values between the two groups until the 5 th POD did not show any significant difference(P <0.001). Conclusions An early and persistent elevation of serum CRP levels after colorectal surgery is suggestive of anastomotic leakage. Patients with anastomotic leakage can have early changes to CRP in advance WBC.
引文
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[11]Ortega-Deballon P,Radais F,Facy O,et al.C-reactive protein is an early predictor of septic complications after elective colorectal surgery[J].World J Surg,2010,34(4):808-814.
[12]Alves A,Panis Y,Trancart D,et al.Factors associated with clinically significant anastomotic leakage after large bowel resection:multivariate analysis of 707 patients[J].World J Surg,2002,26(4):499-502.
[13]Chang PH,Pan YP,Fan CW,et al.Pretreatment serum interleukin-1β,interleukin-6,and tumor necrosis factor-αlevels predict the progression of colorectal cancer[J].Cancer Med,2016,5(3):426-433.
[14]Bokey EL,Chapuis PH,Fung C.Postoperative morbidity andmortality following resection of the colon and rectum for cancer[J].Dis Colon Rectum,1995,38(5):480-487.
[15]Shibutani M,Maeda K,Nagahara H,et al.Prognostic Significance of the Preoperative Ratio of C-Reactive Protein to Albumin in Patients with Colorectal Cancer[J].Anticancer Res,2016,36(3):995-1001.
[16]Almeida AB,Faria G,Moreira H,et al.Elevated serum C-reactive protein as a predictive factor for anastomotic leakage in colorectal surgery[J].Int J Surg,2012,10(2):87-91.
[2]Veyrie N,Ata T,Muscari F,et al.Anastomotic leakage after elective right versus left colectomy for cancer:prevalence and independent risk factors[J].J Am Coll Surg,2007,205(6):785-793.
[3]Bilgin IA,Hatipoglu E,Aghayeva A,et al.Predicting Value of Serum Procalcitonin,C.-Reactive Protein,Drain Fluid Culture,Drain Fluid Interleukin-6,and Tumor Necrosis Factor-αLevels in Anastomotic Leakage after Rectal Resection[J].Surg Infect(Larchmt),2017,18(3):350-356.
[4]Matthiessen P,Henriksson M,Hallb k O,et al.Increase of serum C-reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection[J].Colorectal Dis,2008,10(1):75-80.
[5]Welsch T,Maller SA,Ulrich A,et al.C-Reac-tive protein as early predictor for infectious postoperative complications in rectal surgery[J].Int J Colorectal Dis,2007,22(12):1499-1507.
[6]Welsch T,Frommhold K,Hinz U,et al.Persisting elevation of C-reactive protein after pancreatic resections can indicate developing inflammatory complications[J].Surgery,2008,143(1):20-28.
[7]Deitmar S,Anthoni C.,Palmes D,et al.Are leucocytes and CRP early indicators for anastomotic leakage after esophageal resection?[J].Zentralbl Chir,2009,134(1):83-89.
[8]Waterland P,Ng J,Jones A,et al.Using CRP to predict anastomotic leakage after open and laparoscopic colorectal surgery:is there a difference?[J].Int J Colorectal Dis,2016,31(4):861-868.
[9]Bellows CF,Webber LS,Albo D,et al.Early predictors of anastomotic leaks after colectomy[J].Tech Coloproctol,2009,13(1):41-47.
[10]Kingham TP,Pachter HL.Colonic anastomosis leak:risk factors,diagnosis,and treatment[J].J Am Coll Surg,2009,208(2):269-278.
[11]Ortega-Deballon P,Radais F,Facy O,et al.C-reactive protein is an early predictor of septic complications after elective colorectal surgery[J].World J Surg,2010,34(4):808-814.
[12]Alves A,Panis Y,Trancart D,et al.Factors associated with clinically significant anastomotic leakage after large bowel resection:multivariate analysis of 707 patients[J].World J Surg,2002,26(4):499-502.
[13]Chang PH,Pan YP,Fan CW,et al.Pretreatment serum interleukin-1β,interleukin-6,and tumor necrosis factor-αlevels predict the progression of colorectal cancer[J].Cancer Med,2016,5(3):426-433.
[14]Bokey EL,Chapuis PH,Fung C.Postoperative morbidity andmortality following resection of the colon and rectum for cancer[J].Dis Colon Rectum,1995,38(5):480-487.
[15]Shibutani M,Maeda K,Nagahara H,et al.Prognostic Significance of the Preoperative Ratio of C-Reactive Protein to Albumin in Patients with Colorectal Cancer[J].Anticancer Res,2016,36(3):995-1001.
[16]Almeida AB,Faria G,Moreira H,et al.Elevated serum C-reactive protein as a predictive factor for anastomotic leakage in colorectal surgery[J].Int J Surg,2012,10(2):87-91.