结直肠漏评分联合中性粒细胞...术后吻合口漏的预测价值研究_焦成功.pdf

现代生物医学进展Progress in Modern Biomedicine Vol.23NO.2JAN.2023doi:10.13241/ki.pmb.2023.02.026结直肠漏评分联合中性粒细胞与淋巴细胞比值、C 反应蛋白与白蛋白比值对直肠癌 Dixon 术后吻合口漏的预测价值研究*焦成功颜登国王新俊舒海韵潘军（贵州医科大学附属医院肛肠外科 贵州 贵阳 550001）摘要 目的：研究结直肠漏评分（CLS）联合中性粒细胞与淋巴细胞比值（NLR）、C 反应蛋白与白蛋白比值（CAR）对直肠癌低位前切除（Dixon）术后吻合口漏的预测价值。方法：选取 2020 年 4 月-2022 年 3 月于贵州医科大学附属医院行直肠癌 Dixon 手术的260 例患者，根据术后吻合口漏发生情况分为吻合口漏组与无吻合口漏组。收集患者临床资料，术后评估两组 CLS 评分，术后第1、3 d 检测中性粒细胞、淋巴细胞计数、C 反应蛋白和白蛋白，计算 NLR、CAR；采用 Logistics 回归分析术后吻合口漏的影响因素，采用受试者工作特征（ROC）曲线分析 CLS、NLR、CAR 对吻合口漏的预测价值。结果：260 例患者术后发生 20 例吻合口漏，发生率为 7.69%。吻合口漏组 CLS 评分高于无吻合口漏组（P0.05）；术后第 1 d 两组 NLR、CAR 比较差异无统计学意义（P0.05），术后第 3 d 吻合口漏组 NLR、CAR 高于无吻合口漏组（P0.05）。两组吻合口至肛缘距离、糖尿病史、术前低蛋白血症、术前肠梗阻占比比较差异有统计学意义（P0.05）。多因素 Logistics 回归分析显示，吻合口距肛缘距离、糖尿病史、术前低蛋白血症、术前肠梗阻、CLS、NLR、CAR 是患者术后发生吻合口漏的影响因素（P0.05）。ROC 曲线分析显示，CLS 的曲线下面积（AUC）为 0.851，NLR 的 AUC 为 0.861，CAR 的 AUC 为 0.859，三者联合的 AUC 为 0.945，高于单独检测。结论：Dixon 术后发生吻合口漏患者CLS 评分、NLR 和 CAR 升高，CLS 评分联合 NLR、CAR 可有效预测直肠癌 Dixon 术后吻合口漏发生风险，可作为评估吻合口漏的辅助指标，以降低术后吻合口漏的发生率。关键词：直肠癌；Dixon 手术；结直肠漏评分；NLR；CAR；吻合口漏；预测价值中图分类号：R735.37文献标识码：A文章编号：1673-6273（2023）02-340-05Value Study of Colorectal Leakage Score Combined with Neutrophil toLymphocyte Ratio and C-Reactive Protein to Albumin Ratio in PredictingAnastomotic Leakage after Dixon Operation for Rectal Cancer*JIAO Cheng-gong,YAN Deng-guo,WANG Xin-jun,SHU Hai-yun,PAN Jun(Department of Anorectal Surgery,Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou,550001,China)ABSTRACT Objective:To study the predictive value of colorectal leakage score(CLS)combined with neutrophil to lymphocyteratio(NLR)and C-reactive protein to albumin ratio(CAR)for anastomotic leakage after low anterior resection(Dixon)for rectal cancer.Methods:260 patients who underwent Dixon operation for rectal cancer in Affiliated Hospital of Guizhou Medical University from April2020 to March 2022 were selected.According to the occurrence of postoperative anastomotic leakage,they were divided into anastomot-ic leakage group and non anastomotic leakage group.The clinical data of patients were collectd,the CLS score of the two groups wereevaluated after operation.Neutrophils,lymphocyte count,C-reactive protein and albumin were detected at 1 and 3 d after operation,andthe NLR and CAR were calculated.Logistic regression was used to analyze the influencing factors of postoperative anastomotic leakage,and receiver operating characteristic curve(ROC)was used to analyze the predictive value of CLS,NLR,CAR on anastomotic leakage.Results:20 cases of anastomotic leakage occurred in 260 patients,the incidence rate was 7.69%.The postoperative CLS score of anasto-motic leakage group was higher than that of no anastomotic leakage group(P0.05).There were no significant differences in NLR andCAR between the two groups at 1d after operation(P0.05),and NLR and CAR in the anastomotic leakage group were higher than thosein the non anastomotic leakage group at 3d after operation(P0.05).There were significant differences in the distance from the anasto-mosis to the anal margin,diabetes history,preoperative hypoproteinemia and the proportion of preoperative intestinal obstructionbetween the two groups(P0.05).Multivariate Logistic regression analysis showed that distance from the anastomosis to the anal margin,diabetes history,preoperative hypoproteinemia,preoperative intestinal obstruction,CLS,NLR and CAR were the influencing factors ofpostoperative anastomotic leakage(P0.05).ROC curve analysis showed that the area under the curve(AUC)of CLS was 0.851,AUC*基金项目：国家自然科学基金培育项目（19NSP045）作者简介：焦成功（1994-），男，硕士研究生，从事结直肠癌方向的研究，E-mail:通讯作者：颜登国（1970-），男，博士，主任医师，从事结直肠癌方向的研究，E-mail:（收稿日期：2022-05-18 接受日期：2022-06-15）340现代生物医学进展Progress in Modern Biomedicine Vol.23NO.2JAN.2023of NLR was 0.861,and AUC of CAR was 0.859,the AUC of the combination of the three was 0.945,which was higher than that of singledetection.Conclusion:CLS score,NLR and CAR of patients with anastomotic leakage after Dixon operation increase,CLS scorecombined with NLR and CAR can effectively predict the risk of anastomotic leakage after Dixon operation for rectal cancer,and whichcan be used as an auxiliary index to evaluate anastomotic leakage,so as to reduce the incidence of postoperative anastomotic leakage.Key words:Rectal cancer;Dixon operation;Colorectal leakage score;NLR;CAR;Anastomotic leakage;Predictive valueChinese Library Classification(CLC):R735.37Document code:AArticle ID:1673-6273(2023)02-340-05前言直肠癌为常见消化道肿瘤，近年来我国直肠癌发病率逐年上升，成为威胁人们健康的主要疾病1,2。手术是治疗直肠癌的重要方式，低位前切除（Dixon）术为常用手术3，疗效得到临床认可，但术后易发生吻合口漏，且大多发生在术后 57 d，严重影响患者术后恢复，延长住院时间，增加其医疗负担，甚至威胁生命4,5。故寻找相关指标预测术后吻合口漏发生风险成为了临床研究重点。结直肠漏评分（CLS）是由国外学者提出的针对左半结直肠癌切除术后评估吻合口漏的指标6，近年来国内临床将其应用于左侧结直肠切除术后吻合口漏的评估7。中性粒细胞与淋巴细胞比值（NLR）不仅反映了炎症程度，还被证实与肿瘤预后有关8，可预测结直肠癌患者预后9，但 NLR 能否用于预测直肠癌术后吻合口漏尚不明确。C 反应蛋白与白蛋白比值（CAR）最初被作为创伤后预警指标，随着研究进展，发现 CAR可预测结直肠癌患者预后10,11。因此，本研究分析 Dixon 术后发生吻合口漏的影响因素，探究 CLS 评分联合 NLR、CAR 对吻合口漏的预测价值，旨在寻找相关指标评估和预测术后吻合口漏发生风险。1 资料与方法1.1 一般资料选取 2020 年 4 月-2022 年 3 月于贵州医科大学附属医院行直肠癌 Dixon 手术的 260 例患者，其中男 153 例，女 107 例；年龄为 2