Significance on Combined Detection of White Blood Cell Count and C Reactive Protein for The Early Diagnosis of Anastomotic Leakage after Colon Cancer Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 冯斌 ¹ , 郭勇 ¹ , 吴磊 ¹ , 王卫红 ² , 司世同 ¹

Corresponding author：

冯斌, Email: majjy3721@163.com

Keywords：

白细胞计数; C反应蛋白; 吻合口漏; 早期诊断; 结肠癌

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目的　探讨联合检测白细胞计数和C反应蛋白对早期诊断结肠癌术后吻合口漏的意义。
方法　回顾性分析山东省菏泽市立医院胃肠外科2009～2012年期间收治的183例结肠癌患者的临床资料，其中术后未发生吻合口漏171例（无吻合口漏组），发生吻合口漏12例（有吻合口漏组），所有患者在术前和术后均无其他感染性并发症。对2组患者术前和术后白细胞计数及C反应蛋白浓度进行了观察与分析。
结果　有吻合口漏组患者的平均住院时间为（35±5） d，术后死亡3例（25.0%），长于或高于无吻合口漏组的（12±2） d及5例（2.9%），P＜0.05。术后2组患者白细胞计数在发生漏早期无明显差异，有吻合口漏组患者白细胞计数在漏出现临床症状时显著升高（P＜0.05）。术后2组患者C反应蛋白浓度都较术前增高，无吻合口漏组患者在术后第3天开始逐渐降低；有吻合口漏组患者在术后第4天至第11天与无吻合口漏组患者相比明显增高（P＜0.05）。
结论　C反应蛋白相对于白细胞计数在早期诊断吻合口漏方面具有更重要的意义，术后第4天以后出现的C反应蛋白下降后再次上升或持续性升高可能提示有吻合口漏发生。

Citation： 冯斌,郭勇,吴磊,王卫红,司世同. Significance on Combined Detection of White Blood Cell Count and C Reactive Protein for The Early Diagnosis of Anastomotic Leakage after Colon Cancer Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(7): 800-803. doi: Copy

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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.	周岩，李同凯，白杰. C-反应蛋白、血糖测定及 APACHEⅡ评分在全身炎症反应综合征中的应用[J]. 中国综合临床， 2009， 25(2)： 206-208.

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. 周岩，李同凯，白杰. C-反应蛋白、血糖测定及 APACHEⅡ评分在全身炎症反应综合征中的应用[J]. 中国综合临床， 2009， 25(2)： 206-208.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Significance on Combined Detection of White Blood Cell Count and C Reactive Protein for The Early Diagnosis of Anastomotic Leakage after Colon Cancer Surgery

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