• 1.山東省菏澤市立醫(yī)院胃腸外科（山東菏澤 274000）;;
  • 2. 菏澤學院保健科（山東菏澤 274000）;

目的 　探討聯(lián)合檢測白細胞計數(shù)和C反應(yīng)蛋白對早期診斷結(jié)腸癌術(shù)后吻合口漏的意義。
方法 　回顧性分析山東省菏澤市立醫(yī)院胃腸外科2009～2012年期間收治的183例結(jié)腸癌患者的臨床資料，其中術(shù)后未發(fā)生吻合口漏171例（無吻合口漏組），發(fā)生吻合口漏12例（有吻合口漏組），所有患者在術(shù)前和術(shù)后均無其他感染性并發(fā)癥。對2組患者術(shù)前和術(shù)后白細胞計數(shù)及C反應(yīng)蛋白濃度進行了觀察與分析。
結(jié)果 　有吻合口漏組患者的平均住院時間為（35±5） d，術(shù)后死亡3例（25.0%），長于或高于無吻合口漏組的（12±2） d及5例（2.9%），P＜0.05。術(shù)后2組患者白細胞計數(shù)在發(fā)生漏早期無明顯差異，有吻合口漏組患者白細胞計數(shù)在漏出現(xiàn)臨床癥狀時顯著升高（P＜0.05）。術(shù)后2組患者C反應(yīng)蛋白濃度都較術(shù)前增高，無吻合口漏組患者在術(shù)后第3天開始逐漸降低；有吻合口漏組患者在術(shù)后第4天至第11天與無吻合口漏組患者相比明顯增高（P＜0.05）。
結(jié)論 　C反應(yīng)蛋白相對于白細胞計數(shù)在早期診斷吻合口漏方面具有更重要的意義，術(shù)后第4天以后出現(xiàn)的C反應(yīng)蛋白下降后再次上升或持續(xù)性升高可能提示有吻合口漏發(fā)生。

引用本文： 馮斌,郭勇,吳磊,王衛(wèi)紅,司世同. 聯(lián)合檢測白細胞計數(shù)和C反應(yīng)蛋白對早期診斷結(jié)腸癌術(shù)后吻合口漏的意義. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(7): 800-803. doi: 復制

1. Hyman NH， Osler T， Cataldo P， et al. Anastomotic leaks afterbowel resection：what does peer review teach us about the relatio-nship to postoperative mortality?[J]. J Am Coll Surg， 2009， 208(1)：48-52.
2. Buchs NC， Gervaz P， Secic M， et al. Incidence， consequences， and risk factors for anastomotic dehiscence after colorectal surgery：a prospective monocentric study[J]. Int J Colorectal Dis， 2008， 23(3)：265-270.
3. Law WL， Choi HK， Lee YM， et al. Anastomotic leakage is asso-ciated with poor long-term outcome in patients after curative colorectal resection for malignancy[J]. J Gastrointest Surg， 2007， 11(1)： 8-15.
4. Petersen S， Freitag M， Hellmich G， et al. Anastomotic leakage：impact on local recurrence and survival in surgery of colorectal cancer[J]. Int J Colorectal Dis， 1998， 13(4)：160-163.
5. Bokey EL， Chapuis PH， Fung C. Postoperative morbidity and mortality following resection of the colon and rectum for cancer[J]. Dis Colon Rectum ， 1995， 38(5)： 480-487.
6. Alves A， Panis Y， Pocard M， et al. Management of anastomotic leakage after nondiverted large bowel resection[J]. J Am Coll Surg， 1999， 189(6)：554-559.
7. Konishi T， Watanabe T， Kishimoto J， et al. Risk factors for anastomotic leakage after surgery for colorectal cancer：results of prospective surveillance[J]. J Am Coll Surg， 2006， 202(3)：439-444.
8. Matthiessen P， Henriksson M， Hallböök O， et al. Increase of serumC-reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection[J]. Colorectal Dis， 2008， 10(1)：75-80.
9. Peel AL， Taylor EW. Proposed definitions for the audit of postoperative infection：a discussion paper. Surgical Infection Study Group[J]. Ann R Coll Surg Engl， 1991， 73(6)：385-388.
10. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference： definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis[J]. Crit Care Med， 1992， 20(6)：864-874.
11. Levy MM， Fink MP， Marshall JC， et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference[J]. Crit Care Med， 2003， 31(4)：1250-1256.
12. Macarthur DC， Nixon SJ， Aitken RJ. Avoidable deaths still occurafter large bowel surgery. Scottish Audit of Surgical Mortality， Royal College of Surgeons of Edinburgh[J]. Br J Surg， 1998， 85(1)：80-83.
13. Kingham TP， Pachter HL. Colonic anastomosis leak： risk factors，diagnosis， and treatment[J]. J Am Coll Surg， 2009， 208(2)：269-278.
14. Doeksen A， Tanis PJ， Vrouenraets BC， et al. Factors determiningdelay in relaparotomy for anastomotic leakage after colorectal rese-ction[J]. World J Gastroenterol， 2007， 13(27)：3721-3725.
15. Alves A， Panis Y， Trancart D， et al. Factors associated with clinically significant anastomotic leakage after large bowel resection： multivariate analysis of 707 patients[J]. World J Surg， 2002， 26(4)：499-502.
16. Welsch T， Müller SA， Ulrich A， et al. C-reactive protein as early predictor for infectious postoperative complications in rectal surgery[J]. Int J Colorectal Dis， 2007， 22(12)：1499-1507.
17. Lee SY， Park KH， Oh KJ， et al. The relationship of serumC-reactive protein and clinical chorioamnionitis， funisitis， and early-onset neonatal sepsis in preterm delivery[J]. Am J Obstet Gynecol， 2011， 204( Suppl) ：S210.
18. Pepys MB， Hirschfield GM. C-reactive protein：a critical update[J]. J Clin Invest， 2003， 111(12)：1805-1812.
19. Groblewska M， Mroczko B， Wereszczyńska-Siemiatkowska U， et al. Serum interleukin 6 (IL-6) and C-reactive protein (CRP)levels in colorectal adenoma and cancer patients[J]. Clin Chem Lab Med， 2008， 46(10)： 1423-1428.
20. Peisajovich A， Marnell L， Mold C， et al. C-reactive protein at the interface between innate immunity and inflammation[J]. ExpertRev Clin Immunol， 2008， 4(3)：379-390.
21. Sander LE， Sackett SD， Dierssen U， et al. Hepatic acutephase proteins control innate immune responses during infection by promoting myeloid-derived suppressor cell function[J]. J Exp Med， 2010， 207(7)：1453-1464.
22. Meisner M， Tschaikowsky K， Hutzler A， et al. Postoperative plasma concentrations of procalcitonin after different types of surgery[J]. Intensive Care Med， 1998， 24(7)：680-684.
23. Woeste G， Muller C， Bechstein WO， et al. Increasesed serum levels of C-reactive protein precede anastomotic leakage in colorectal surgery[J]. World J Surg， 2010， 34(1)：140-146.
24. Mackay GJ， Molloy RG， O’Dwyer PJ. C-reactive protein as a predictor of postoperative infective complications following electivecolorectal resection[J]. Colorectal Dis， 2011， 13(5)：583-587.
25. Kørner H， Nielsen HJ， Søreide JA， et al. Diagnostic accuracy of C-reactive protein for intraabdominal infections after colorectal resections[J]. J Gastrointest Surg， 2009， 13(9)：1599-1606.
26. Deitmar S， Anthoni C， Palmes D， et al. Are leukocytes and CRP early indicators for anastomotic leakage after esophageal resection?[J]. Zentralbl Chir， 2009， 134(1)：83-89.
27. Welsch T， Frommhold K， Hinz U， et al. Persisting elevation of C-reactive protein after pancreatic resections can indicate developing inflammatory complications[J]. Surgery， 2008， 143(1)：20-28.
28. Millan M， Garcia-Granero E， Flor B， et al. Early prediction of anastomotic leak in colorrectal cancer surgery by intramucosal pH[J]. Dis Colon Rectum， 2006， 49(5)：595-601.
29. 周巖， 李同凱， 白杰. C-反應(yīng)蛋白、血糖測定及 APACHEⅡ評分在全身炎癥反應(yīng)綜合征中的應(yīng)用[J]. 中國綜合臨床， 2009， 25(2)： 206-208.
  1. 1. Hyman NH， Osler T， Cataldo P， et al. Anastomotic leaks afterbowel resection：what does peer review teach us about the relatio-nship to postoperative mortality?[J]. J Am Coll Surg， 2009， 208(1)：48-52.
  2. 2. Buchs NC， Gervaz P， Secic M， et al. Incidence， consequences， and risk factors for anastomotic dehiscence after colorectal surgery：a prospective monocentric study[J]. Int J Colorectal Dis， 2008， 23(3)：265-270.
  3. 3. Law WL， Choi HK， Lee YM， et al. Anastomotic leakage is asso-ciated with poor long-term outcome in patients after curative colorectal resection for malignancy[J]. J Gastrointest Surg， 2007， 11(1)： 8-15.
  4. 4. Petersen S， Freitag M， Hellmich G， et al. Anastomotic leakage：impact on local recurrence and survival in surgery of colorectal cancer[J]. Int J Colorectal Dis， 1998， 13(4)：160-163.
  5. 5. Bokey EL， Chapuis PH， Fung C. Postoperative morbidity and mortality following resection of the colon and rectum for cancer[J]. Dis Colon Rectum ， 1995， 38(5)： 480-487.
  6. 6. Alves A， Panis Y， Pocard M， et al. Management of anastomotic leakage after nondiverted large bowel resection[J]. J Am Coll Surg， 1999， 189(6)：554-559.
  7. 7. Konishi T， Watanabe T， Kishimoto J， et al. Risk factors for anastomotic leakage after surgery for colorectal cancer：results of prospective surveillance[J]. J Am Coll Surg， 2006， 202(3)：439-444.
  8. 8. Matthiessen P， Henriksson M， Hallböök O， et al. Increase of serumC-reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection[J]. Colorectal Dis， 2008， 10(1)：75-80.
  9. 9. Peel AL， Taylor EW. Proposed definitions for the audit of postoperative infection：a discussion paper. Surgical Infection Study Group[J]. Ann R Coll Surg Engl， 1991， 73(6)：385-388.
  10. 10. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference： definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis[J]. Crit Care Med， 1992， 20(6)：864-874.
  11. 11. Levy MM， Fink MP， Marshall JC， et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference[J]. Crit Care Med， 2003， 31(4)：1250-1256.
  12. 12. Macarthur DC， Nixon SJ， Aitken RJ. Avoidable deaths still occurafter large bowel surgery. Scottish Audit of Surgical Mortality， Royal College of Surgeons of Edinburgh[J]. Br J Surg， 1998， 85(1)：80-83.
  13. 13. Kingham TP， Pachter HL. Colonic anastomosis leak： risk factors，diagnosis， and treatment[J]. J Am Coll Surg， 2009， 208(2)：269-278.
  14. 14. Doeksen A， Tanis PJ， Vrouenraets BC， et al. Factors determiningdelay in relaparotomy for anastomotic leakage after colorectal rese-ction[J]. World J Gastroenterol， 2007， 13(27)：3721-3725.
  15. 15. Alves A， Panis Y， Trancart D， et al. Factors associated with clinically significant anastomotic leakage after large bowel resection： multivariate analysis of 707 patients[J]. World J Surg， 2002， 26(4)：499-502.
  16. 16. Welsch T， Müller SA， Ulrich A， et al. C-reactive protein as early predictor for infectious postoperative complications in rectal surgery[J]. Int J Colorectal Dis， 2007， 22(12)：1499-1507.
  17. 17. Lee SY， Park KH， Oh KJ， et al. The relationship of serumC-reactive protein and clinical chorioamnionitis， funisitis， and early-onset neonatal sepsis in preterm delivery[J]. Am J Obstet Gynecol， 2011， 204( Suppl) ：S210.
  18. 18. Pepys MB， Hirschfield GM. C-reactive protein：a critical update[J]. J Clin Invest， 2003， 111(12)：1805-1812.
  19. 19. Groblewska M， Mroczko B， Wereszczyńska-Siemiatkowska U， et al. Serum interleukin 6 (IL-6) and C-reactive protein (CRP)levels in colorectal adenoma and cancer patients[J]. Clin Chem Lab Med， 2008， 46(10)： 1423-1428.
  20. 20. Peisajovich A， Marnell L， Mold C， et al. C-reactive protein at the interface between innate immunity and inflammation[J]. ExpertRev Clin Immunol， 2008， 4(3)：379-390.
  21. 21. Sander LE， Sackett SD， Dierssen U， et al. Hepatic acutephase proteins control innate immune responses during infection by promoting myeloid-derived suppressor cell function[J]. J Exp Med， 2010， 207(7)：1453-1464.
  22. 22. Meisner M， Tschaikowsky K， Hutzler A， et al. Postoperative plasma concentrations of procalcitonin after different types of surgery[J]. Intensive Care Med， 1998， 24(7)：680-684.
  23. 23. Woeste G， Muller C， Bechstein WO， et al. Increasesed serum levels of C-reactive protein precede anastomotic leakage in colorectal surgery[J]. World J Surg， 2010， 34(1)：140-146.
  24. 24. Mackay GJ， Molloy RG， O’Dwyer PJ. C-reactive protein as a predictor of postoperative infective complications following electivecolorectal resection[J]. Colorectal Dis， 2011， 13(5)：583-587.
  25. 25. Kørner H， Nielsen HJ， Søreide JA， et al. Diagnostic accuracy of C-reactive protein for intraabdominal infections after colorectal resections[J]. J Gastrointest Surg， 2009， 13(9)：1599-1606.
  26. 26. Deitmar S， Anthoni C， Palmes D， et al. Are leukocytes and CRP early indicators for anastomotic leakage after esophageal resection?[J]. Zentralbl Chir， 2009， 134(1)：83-89.
  27. 27. Welsch T， Frommhold K， Hinz U， et al. Persisting elevation of C-reactive protein after pancreatic resections can indicate developing inflammatory complications[J]. Surgery， 2008， 143(1)：20-28.
  28. 28. Millan M， Garcia-Granero E， Flor B， et al. Early prediction of anastomotic leak in colorrectal cancer surgery by intramucosal pH[J]. Dis Colon Rectum， 2006， 49(5)：595-601.
  29. 29. 周巖， 李同凱， 白杰. C-反應(yīng)蛋白、血糖測定及 APACHEⅡ評分在全身炎癥反應(yīng)綜合征中的應(yīng)用[J]. 中國綜合臨床， 2009， 25(2)： 206-208.