C反应蛋白 降钙素原及引流液细菌培养对直肠癌术后吻合口漏的预测价值

【摘要】 目的 探讨C反应蛋白(CRP)、降钙素原(PCT)及盆腔引流液细菌培养在腹腔镜低位直肠癌术后吻合口漏中的临床预测价值及可行性,以期为吻合口漏的早期诊治提供指导。方法 收集2016年6月至2018年10月行腹腔镜低位直肠癌前切除术患者60例,于术前及术后第1、3天检测血清CRP及PCT质量浓度,术后第1、3、5天无菌法采集盆腔引流液行细菌培养,分析CRP、PCT及细菌培养结果对吻合口漏发生的早期预测价值。结果 60例患者均顺利完成手术,术后有8例(13%)发生吻合口漏。吻合口漏组患者血清CRP、PCT水平在术后第3天明显高于非吻合口漏组,差异有统计学意义(P<0.05)。吻合口漏组引流液细菌培养阳性率在术后第1、3、5天分别是25%、62.5%和85.7%,均较非吻合口漏组高,但仅在第3、5天差异有统计学意义(P<0.05)。结论 腹腔镜低位直肠癌术后第3天出现高水平CRP、PCT应警惕吻合口漏发生,建议影像学评估。盆腔引流液细菌培养阳性率升高对吻合口漏有早期预测价值。更多还原

【Abstract】 Objective To investigate the value and feasibility of C-reactive protein(CRP),procalcitonin(PCT) and drainage-fluid culture in predicting postoperative anastomotic leak(AL) in patients who underwent laparoscopic anterior resection for lower rectal cancer,so as to provide evidence for early early diagnosis and treatment of AL.Methods From June 2016 to October 2018,sixty cases undergoing laparoscopic anterior resection for lower rectal cancer in HuZhou Central Hospital were selected.The serum CRP and PCT level were measured before operation and 1 st,3 rd day after operation.Bacterial culture were performed from the samples obtained from drain fluid by aseptic method on post-operative days one,three,and five.The biomarkers level of the groups with and without AL was compared to analyze its prediction for AL.Results All the 60 patients underwent surgery successfully and AL occurred in eight of 60(13%) patients.Compare with non-AL group,serum CRP and PCT levels at postoperative day three were higher in AL group(all P<0.05).Culture results of drain fluid in the AL group were positive at a rate of 25% at the first,62.5% at the third and 85.7% at the fifth post-operative days,higher than non-AL group.The difference of the third and fifth post-operative days’ levels between groups was statistically significant(all P<0.05).Conclusions High serum CRP and PCT values on post-operative day three are alarming,and assessment of AL by imaging examination is suggested.Culture results of drain fluid have early predictive value for AL,which is conducive to the safe development of laparoscopic minimally invasive technology.更多还原