摘要
目的探讨C反应蛋白(CRP)及降钙素原(PCT)预测腹腔镜直肠癌术后吻合口漏的临床价值.方法选择腹腔镜全直肠系膜切除术(LTME)治疗的直肠癌患者临床资料.根据吻合口漏(AL)定义将100例患者分为非AL组与AL组,所有患者在术前及术后7 d(POD1,POD2,POD3,POD4,POD5,POD6,POD7)测定血清CRP及PCT水平.结果两组患者围手术期均未发生院内死亡,均无中转开腹患者.AL组患者术后7 d内CRP及PCT的水平显著高于非AL组,且差异均具有统计学意义(P<0.05); AL组患者CRP水平在POD3时出现首次峰值,PCT水平在POD4时出现首次峰值.CRP在POD3时(AUC:0.778,截断值:136.7,95%CI:0.667~0.890) AUC值最大,PCT在POD4时(AUC:0.877,截断值:8.57,95%CI:0.798~0.933) AUC值最大.CRP联合PCT的首次峰值AUC为0.938(95%CI:0.874~0.976),敏感度为97.6%,特异度为82.8%.结论 CRP及PCT作为AL的一个预测实验室指标其可行度较高,但CRP及PCT首次出现的峰值预测AL准确度更高.
Objective To explore the clinical value of C-reactive protein(CRP) and procalcitonin(PCT) in predicting anastomotic leakage after laparoscopic rectal cancer surgery. Method The clinical data of patients with rectal cancer treated by laparoscopic total mesorectal excision(LTME) were selected. According to the definition of anastomotic leakage(AL),100 patients were divided into non-AL group and AL group.Serum CRP and PCT levels were measured before operation and 7 days after operation(POD1,POD2,POD3,POD4,POD5,POD6,POD7). Results There were no deaths and no conversion to laparotomy in both groups during perioperative period.The levels of CRP and PCT in AL group were significantly higher than those in non-AL group within 7 days after operation(P<0.05).The first peak of CRP level appeared at POD3 and PCT level at POD4 in AL group.CRP had the highest AUC value at POD3(AUC: 0.778,best truncation value: 136.7,95%CI: 0.667 ~ 0.890),PCT had the highest AUC value at POD4(AUC: 0.877,best truncation value: 8.57,95% CI:0.798 ~ 0.933).The first peak AUC of CRP combined with PCT was 0.938(95% CI: 0.874 ~ 0.976),sensitivity was 97.6%,specificity was 82.8%.Conclusion CRP and PCT as a predictive laboratory index of AL have high feasibility. However,the peak values of CRP and PCT for the first time in the change are more accurate in predicting AL.
引文
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