血清C 反应蛋白对直肠癌患者术后 吻合口瘘的预测价值

Predictive effect of serum CRP on anastomotic leakage after rectal cancer in patients with different conditions

摘要:

目的 探究血清C 反应蛋白（CRP）对直肠癌行腹腔镜手术后吻合口瘘的预测效果。方法 选取 2014 年1 月—2018 年11 月在江苏大学附属医院行腹腔镜手术的141 例患者。其中，发生吻合口瘘的22 例患 者作为观察组，未发生吻合口瘘的119 例患者作为对照组。分析两组手术前后7 d 内患者血清CRP 水平变 化。结果 两组血清CRP 水平比较，采用重复测量设计的方差分析，结果：①不同时间点血清CRP 有差别 （F =116.970，P =0.000）；②两组血清CRP 有差别（F =241.717，P =0.000）；③两组血清CRP 变化趋势有差 别（F =32.776，P =0.000）。行预防性造口组与未行预防性造口组血清CRP 水平比较，采用重复测量设计的 方差分析，结果：①不同时间点的血清CRP 有差别（F =28.057，P =0.000）；两组间的血清CRP 无差别（F =0.009， P =0.927）；③两组血清CRP 变化趋势无差别（F =0.029，P =0.993）。低位组与高位组血清CRP 水平比较， 采用重复测量设计的方差分析，结果：①不同时间点血清CRP 有差别（F =22.473，P =0.000）；②两组血清 CRP 无差别（F =0.197，P =0.662）；③两组血清CRP 变化趋势无差别（F =0.017，P =0.997）。术后3 d 患者 ROC 曲线下面积最大，达到0.902（95% CI ：0.613，1.000）。血清CRP 临界点为80.13 mg/L，预测吻合口瘘 的敏感性为0.821（95% CI ：0.648，0.994），特异性为0.859（95% CI ：0.733，0.985）。结论 直肠癌患者行腹 腔镜手术后可以通过其血清CRP 水平预测吻合口瘘的发生。

Abstract:

Objective To investigate the predictive effect of serum CRP on anastomotic leakage after laparoscopic surgery for rectal cancer. Methods From January 2014 to February 2018, 141 patients who underwent laparoscopic surgery in our hospital were divided into observation group and control group according to whether there was anastomotic leakage after laparoscopic surgery. The patients were set as the observation group, and 119 patients without anastomotic leakage were set as the control group. The changes and trends of serum CRP levels in the two groups before and 7 days after surgery were observed and recorded. The differences were compared and analyzed. Results There were differences in serum CRP between the observation group and the control group at different time points (F = 116.970, P = 0.000); there was a difference between the experimental group and the control group (F = 241.717, P = 0.000); there was a difference in the trend of serum CRP in the control group (F = 32.776, P = 0.000), which was significant (P < 0.05); there was a difference in serum CRP between the two groups in the preventive stoma group and the non-prophylactic stoma group (F = 28.057, P = 0.000); there was no difference in serum CRP between the two groups (F = 0.009, P = 0.927), and there was no difference in the trend of serum CRP (F = 0.029, P = 0.993). There was a difference in serum CRP between the low and high groups (F = 22.473, P = 0.000); there was no difference in serum CRP between the two groups (F = 0.197, P = 0.662); there was no difference in the trend of serum CRP (F = 0.017, P = 0.997). After 3 days, the area under the ROC curve was the largest, reaching 0.902 (95% CI: 0.613, 1.000); the critical point of serum CRP was 80.13 mg/L, and the sensitivity of predicting anastomotic leakage was 0.821 (95% CI: 0.648, 0.994), the specificity was 0.859 (95% CI: 0.733, 0.985). Conclusion Patients with rectal cancer can predict the occurrence of anastomotic leakage through urinary CRP levels after laparoscopic surgery.