| 焦成功,颜登国,王新俊,舒海韵,潘 军.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[J].,2023,(2):340-344 |
| 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 |
| Value Study of Colorectal Leakage Score Combined with Neutrophil to Lymphocyte Ratio and C-Reactive Protein to Albumin Ratio in Predicting Anastomotic Leakage after Dixon Operation for Rectal Cancer |
| 投稿时间：2022-05-18 修订日期：2022-06-15 |
| DOI：10.13241/j.cnki.pmb.2023.02.026 |
| 中文关键词: 直肠癌 Dixon手术 结直肠漏评分 NLR CAR 吻合口漏 预测价值 |
| 英文关键词: Rectal cancer Dixon operation Colorectal leakage score NLR CAR Anastomotic leakage Predictive value |
| 基金项目:国家自然科学基金培育项目（19NSP045） |
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| 中文摘要: |
| 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（P＜0.05）；术后第1 d两组NLR、CAR比较差异无统计学意义（P＞0.05），术后第3 d吻合口漏组NLR、CAR高于无吻合口漏组（P＜0.05）。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（P＜0.05）。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（P＜0.05）。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。 |
| 英文摘要: |
| ABSTRACT Objective: To study the predictive value of colorectal leakage score (CLS) combined with neutrophil to lymphocyte ratio (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 April 2020 to March 2022 were selected. According to the occurrence of postoperative anastomotic leakage, they were divided into anastomotic leakage group and non anastomotic leakage group. The clinical data of patients were collectd, the CLS score of the two groups were evaluated after operation. Neutrophils, lymphocyte count, C-reactive protein and albumin were detected at 1 and 3 d after operation, and the 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 anastomotic leakage group was higher than that of no anastomotic leakage group(P＜0.05). There were no significant differences in NLR and CAR between the two groups at 1d after operation (P>0.05), and NLR and CAR in the anastomotic leakage group were higher than those in the non anastomotic leakage group at 3d after operation(P＜0.05). There were significant differences in the distance from the anastomosis to the anal margin, diabetes history, preoperative hypoproteinemia and the proportion of preoperative intestinal obstruction between the two groups(P＜0.05). 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 of postoperative anastomotic leakage(P＜0.05). ROC curve analysis showed that the area under the curve (AUC) of CLS was 0.851, AUC of 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 single detection. Conclusion: CLS score, NLR and CAR of patients with anastomotic leakage after Dixon operation increase, CLS score combined with NLR and CAR can effectively predict the risk of anastomotic leakage after Dixon operation for rectal cancer, and which can be used as an auxiliary index to evaluate anastomotic leakage, so as to reduce the incidence of postoperative anastomotic leakage. |
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