【摘要】 目的探讨腹腔镜结直肠癌手术患者术前及术后不同时间点血清降钙素原(PCT)水平对于评估术后吻合口漏的临床价值。方法以2014年6月至2015年10月118例行腹腔镜结直肠癌切除术患者作为研究对象,分为吻合口漏组(14例)和未出现吻合口漏对照组(104例),分别在术前、术后第1~5天检测血清PCT水平,使用SPSS 18.0进行统计学分析,组间比较采用t检验,数据以均数±标准差来表示;运用敏感性和特异性评价PCT在早期诊断腹腔镜结直肠癌术后吻合口漏方面的价值,P<0.05差异有统计学意义。结果吻合口漏组患者PCT水平在术后第1天开始上升,在术后第2天PCT显著高于对照组,差异有统计学意义(P<0.05),并且持续维持在较高水平直到明确诊断出术后吻合口漏。术后第5天PCT水平在预测术后吻合口漏的敏感性及特异性最具有优势;此时处于临界水平的PCT对于吻合口漏的阴性预测值为99%,提示当患者在术后第5天PCT水平低于1.22 ng/ml时,几乎不会发生吻合口漏,能够作为早期出院的客观依据。结论结果提示,通过检测患者术后血PCT水平,能为加速康复外科理念下患者的早期出院提供客观依据。当患者术后第3天PCT值小于1.94ng/ml和/或者术后第5天小于1.22 ng/ml时,可以相对安全的认为患者不会出现吻合口漏,能够早期出院。更多还原

【Abstract】 Objective To evaluate the role of procalcitonin in assessing anastomotic leakage after laparoscopic colorectal cancer surgery. Methods We reviewed pre- and postoperative serum PCT in 118 patients who underwent laparoscopic surgery for colorectal cancer between June 2014 and October 2015 at Fujian Province Hospital and South Branch Court of Fujian Province Hospital. Patients with anastomotic leakage(group A,n=14) were compared to those without leakage(group B,n=104). Patients with ongoing infections before surgery or with acquired leakage were excluded. The mean pre- and postoperative values of PCT were compared. SPSS 18. 0 was used for statistical analysis,and ROC was also used to evaluate the sensitivity and specificity of PCT in detecting anastomotic leakage at early stage. All data are presented as mean ± SD. Student’s t test was used to compare the groups. A P value less than 0. 05 was considered statistically significant. Results PCT level in patients with anastomotic leakage( Group A)began to rise on postoperative day 1. The PCT level was significantly higher than that in patients without anastomotic leakage( group B) on postoperative day 2(P<0.05). The PCT level on postoperative day 5was highly effective in predicting the sensitivity and specificity of anastomotic leakage at early stage. The cut-off value of 1.22 ng / ml on postoperative day 5 increased the negative prediction value(99%). The PCTlevel on postoperative day 5,which was lower than 1.22 ng / m L,could be regarded as an objective indicator permiting patients to be discharged from hospitals as they would be unable to develop anastomotic leakage.Conclusion Early and persistent elevation of PCT level after laparoscopic surgery for colorectal cancer with anastomosis is a marker of anastomotic leakage.更多还原