CRP联合PCT首次峰值预测腹腔镜直肠癌术后吻合口漏的临床价值
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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.
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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[4]乐瀚翔,张怀宇,刘铜军.可吸收线单层缝合腹腔镜腹会阴联合切除术会阴部切口的临床观察[J].中华胃肠外科杂志,2018,21(4):461-463.
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[7]刘端,吴俊,吴祥甫.人C-反应蛋白(CRP)基因的克隆及表达研究[J].浙江理工大学学报(自然科学版),2016,35(2):272-276.
[8]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-418.
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[10] C hang H K,Lee S Y,Kim H R,et al. Nomogram prediction of anastomotic leakage and determination of an effective surgical strategy for reducing anastomotic leakage after laparoscopic rectal cancer surgery[J]. Gastroenterology Research and Practice,2017,2017:4510561.
[11] 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 Journal of Surgery,2002,26(4):499-502.
[12]唐敬,赵平,周业江.NLR、PLR及其变化趋势对直肠癌术后吻合口漏预测价值[J].中国免疫学杂志,2017,33(8):1223-1227.
[13] G iaccaglia Valentina,Salvi Pier Federico,Antonelli Maria Serena,et al. Procalcitonin reveals early dehiscence in colorectal surgery:the PREDICS study[J].Annals of Surgery,2016,263(5):967-972.
[14]卢利国,万仁辉,温宜清,等.血清CRP在预测结直肠手术后早期吻合口漏的临床价值[J].消化肿瘤杂志(电子版),2018,10(1):16-20.
[15] Asti E,Bonitta G,Melloni M,et al.Utility of C-reactive protein as predictive biomarker of anastomotic leak after minimally invasive esophagectomy[J]. Langenbecks Archives of Surgery,2018,403(2):235.
[16] Jennifer Stratman,Miguel A Cuesta,Jurriaan B Tuynman,et al. C-reactive protein in predicting major postoperative complications are there differences in open and minimally invasive colorectal surgery? Substudy from a randomized clinical trial[J]. Surgical Endoscopy,2018,32(6):2877-2885.
[17] S cepanovic M S,Cijan V,Antic A,et al. C-reactive protein as an early predictor for anastomotic leakage in elective abdominal surgery[J]. Techniques in Coloproctology,2013,17(5):541-547.
[18] Yuji Takakura,Takao Hinoi,Hiroyuki Egi,et al. Procalcitonin as a predictive marker for surgical site infection in elective colorectal cancer surgery[J]. Langenbeck’s Archives of Surgery,2013,98(6):833-839.
[2] D ai G,Cai Y T,Gao M,et al. Effect of laparoscopy on serum inflammatory factor,oxidative stress and immune function in patients with rectal cancer[J]. Journal of Hainan Medical University,2017,23(17):54-57.
[3]祝鹏杰,崔小兵.低位直肠癌术后吻合口瘘防治的临床研究进展[J].世界临床医学,2017,11(20):108-110.
[4]乐瀚翔,张怀宇,刘铜军.可吸收线单层缝合腹腔镜腹会阴联合切除术会阴部切口的临床观察[J].中华胃肠外科杂志,2018,21(4):461-463.
[5] Voron T,Bruzzi M,Ragot E,et al. Anastomotic location predicts anastomotic leakage after elective colonic resection for cancer[J]. Journal of Gastrointestinal Surgery,2018:1-9.
[6] P ark E J,Baik S H,Kang J,et al. The impact of postoperative complications on long-term oncologic outcomes after laparoscopic low anterior resection for rectal cancer[J].Medicine,2016,95(14):e3271.
[7]刘端,吴俊,吴祥甫.人C-反应蛋白(CRP)基因的克隆及表达研究[J].浙江理工大学学报(自然科学版),2016,35(2):272-276.
[8]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-418.
[9] Chern Y J,Tsai W S,Hung H Y,et al.The dark side of laparoscopic surgery for colorectal cancer patients aged 75years or older[J]. International Journal of Colorectal Disease,2018,33(10):1367-1371.
[10] C hang H K,Lee S Y,Kim H R,et al. Nomogram prediction of anastomotic leakage and determination of an effective surgical strategy for reducing anastomotic leakage after laparoscopic rectal cancer surgery[J]. Gastroenterology Research and Practice,2017,2017:4510561.
[11] 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 Journal of Surgery,2002,26(4):499-502.
[12]唐敬,赵平,周业江.NLR、PLR及其变化趋势对直肠癌术后吻合口漏预测价值[J].中国免疫学杂志,2017,33(8):1223-1227.
[13] G iaccaglia Valentina,Salvi Pier Federico,Antonelli Maria Serena,et al. Procalcitonin reveals early dehiscence in colorectal surgery:the PREDICS study[J].Annals of Surgery,2016,263(5):967-972.
[14]卢利国,万仁辉,温宜清,等.血清CRP在预测结直肠手术后早期吻合口漏的临床价值[J].消化肿瘤杂志(电子版),2018,10(1):16-20.
[15] Asti E,Bonitta G,Melloni M,et al.Utility of C-reactive protein as predictive biomarker of anastomotic leak after minimally invasive esophagectomy[J]. Langenbecks Archives of Surgery,2018,403(2):235.
[16] Jennifer Stratman,Miguel A Cuesta,Jurriaan B Tuynman,et al. C-reactive protein in predicting major postoperative complications are there differences in open and minimally invasive colorectal surgery? Substudy from a randomized clinical trial[J]. Surgical Endoscopy,2018,32(6):2877-2885.
[17] S cepanovic M S,Cijan V,Antic A,et al. C-reactive protein as an early predictor for anastomotic leakage in elective abdominal surgery[J]. Techniques in Coloproctology,2013,17(5):541-547.
[18] Yuji Takakura,Takao Hinoi,Hiroyuki Egi,et al. Procalcitonin as a predictive marker for surgical site infection in elective colorectal cancer surgery[J]. Langenbeck’s Archives of Surgery,2013,98(6):833-839.