作者：卢利国，万仁辉，温宜清，张琳，吕勇

单位：东莞市横沥医院 普外科，广东 东莞 523460

Authors:  LU Liguo, WAN Renhui, WEN Yiqing, ZHANG Lin, LV Yong

Unit:  Department of General Surgery, Dongguan Hengli People’s Hospital, Dongguan 523460, Guangdong, China

摘要：

目的  探讨术后血清C反应蛋白(C-reactive protein, CRP)相较于白细胞计数(white blood count, WBC)在早期诊断结直肠手术后吻合口漏的临床价值。方法  选取2013年1月1日至2016年12月30日在东莞市横沥医院行结直肠手术的患者共80例,根据是否有吻合口漏分为两组,吻合口漏组20例和无吻合口漏组60例。连续检测两组患者术前和术后9天内的血清CRP和WBC,比较两组之间的差异。结果  术后吻合口漏的诊断时间介于术后第3天至第10天(平均时间为术后第5天)。吻合口漏组平均住院时间较无吻合口漏组长(30.1天vs.10.4天,P<0.001)。术后第2天开始吻合口漏组患者的血清CRP平均水平明显高于无吻合口漏组患者(187.3 mg/L vs.137.0 mg/L,P<0.001)。术后第5天开始WBC在吻合口漏组明显高于无吻合口漏组(11.8×109/L vs.8.1×109/L,P<0.001)。结论  结直肠癌手术后CRP早期呈持续性增高,提示可能发生吻合口漏。吻合口漏的患者术后CRP比WBC更早出现变化。

关键词： C反应蛋白; 白细胞计数; 结直肠; 手术; 吻合口漏

Abstract：

Objective  To investigate the predictive value of postoperative serum C reactive protein (CRP) compared with white blood count (WBC) in the early diagnosis of anastomotic leakage after colorectal surgery. Methods  From January 1, 2013 to December 30, 2016, 80 patients who underwent colorectal surgery in our hospital were divided into two groups according to whether anastomotic leakage occurred or not. Patients with anastomotic leakage (n=20) were compared with those without leakage (n=60). Serum levels of CRP and WBC were recorded and analyzed in both groups before operation and within nine days after operation. Results  The diagnosis of anastomotic leakage was confirmed between the 3 rd and 10 th postoperative day (POD) (mean 5 th POD). The average length of stay in the leakage group was longer than that in the group without leakage (P<0.001). The daily average values of serum CRP in leakage group were significantly higher than those in non-leakage group starting at the 2nd POD and remained significantly elevated until the confirmed diagnosis (P<0.001). However, Comparison of postoperative WBC values between the two groups until the 5 th POD did not show any significant difference (P<0.001). Conclusions  An early and persistent elevation of serum CRP levels after colorectal surgery is suggestive of anastomotic leakage. Patients with anastomotic leakage can have early changes to CRP in advance WBC.

Key Words:  C-reactive protein; White blood count; Colorectal; Surgery; Anastomotic leakage