NLR、LMR 与局部进展期直肠癌根治 术后吻合口漏的关系

Correlation analysis of NLR and LMR in occurrence of anastomotic leakage after radical operation of locally advanced rectal cancer

摘要:

目的 探索中性粒细胞/ 淋巴细胞比值（NLR）、淋巴细胞/ 单核细胞比值（LMR）与局部进展 期直肠癌（LARC）根治术后吻合口漏的相关性。方法 选取2016 年1 月—2018 年12 月在西南医科大学附 属医院胃肠外科接受根治手术的368 例LARC 患者作为研究对象。选取NLR、LMR 作为观察指标，同时观 察患者年龄、性别、体重指数（BMI）、临床分期、淋巴结分期、分化程度、血管受侵、术中出血量、肛门排 气排便时间及首次进食时间。结果 单因素分析显示，患者术前NLR、术后NLR、术后NLR/ 术前NLR、 术后LMR、术后LMR/ 术前LMR、术中出血量、年龄及BMI 与吻合口漏相关（P <0.05），而性别、术前 LMR、临床分期、淋巴结分期、分化程度、血管受侵、肛门排气排便时间及首次进食时间与术后吻合口漏无 关（P >0.05）。多因素分析表明，术前NLR、术后NLR、术后NLR/ 术前NLR、年龄及BMI 是LARC 根治 术后发生吻合口漏的独立危险因素（P <0.05）。结论 术前NLR、术后NLR、术后NLR/ 术前NLR、年龄 及BMI 是LARC 患者术后吻合口漏的独立危险因素。当术前NLR ≥ 6.34 时，提示术后吻合口漏的发生风险 更高。

Abstract:

Objective To explore the correlation among neutrophil-lymphocyte ratio (preoperative NLR), lymphocyte-monocyte ratio (preoperative LMR) and the occurrence of anastomotic leakage after radical operation of locally advanced rectal cancer. Methods A total of 368 patients with locally advanced rectal cancer who underwent radical resection from January 2016 to December 2018 were enrolled in the study. NLR, LMR, age, gender, body mass index, tumor pathological stage, lymph node stage, differentiation, venous invasion, blood loss, defecation time and the first eating time were used as the observation indexes. Results Univariate analysis showed that preoperative NLR, postoperative NLR, postoperative NLR/preoperative NLR,postoperative LMR, postoperative LMR/preoperative LMR, blood loss, age and BMI were associated with AL (P < 0.05). Other factors such as gender, preoperative LMR, pathology stage, lymph node stage, differentiation, venous invasion, defecation time and the first eating time were not related to AL (P > 0.05). Multivariate analysis showed that preoperative NLR, postoperati ve NLR, postoperative NLR/preoperative NLR, age and BMI were associated with AL (P < 0.05). Conclusion The preoperative NLR, postoperative NLR, change of NLR ratio (postoperative NLR/preoperative NLR), age and BMI are the independent risk factors of postoperative anastomotic leakage in locally advanced rectal cancer patients. While preoperative NLR ≥ 6.34, AL is more likely to occur (P < 0.05).