降钙素原对食管癌根治术后吻合口瘘早期诊断的意义

Procalcitonin detection in early diagnosis of anastomotic leak after minimally invasive esophagectomy for esophageal cancer

目的 评价降钙素原（Procalcitonin,PCT）对腔镜辅助下Mc Keown术式切除食管癌后吻合口瘘发生早期诊断的意义,为吻合口瘘的早期诊断提供新手段。方法 选择2011年2月—2013年2月腔镜辅助下Mc Keown术式切除食管癌患者为研究对象,监测术后第1、3、5天PCT、CRP水平,记录所有主要并发症。根据是否发生术后吻合口瘘分为吻合口瘘组（AL组）和非吻合口瘘组（非AL组）。绘制ROC曲线评价PCT、CRP诊断术后吻合口瘘的价值。结果 纳入连续性研究对象82例,共发生并发症29例（35.4%）,其中吻合口瘘10例（12.2%）。以术后第5天PCT水平做ROC曲线,AUC 0.894（95%CI：0.806-0.951）,以0.43 ng/ml作为切点值,敏感度100%,特异度74%,NPV 100%,PPV 34%。术后第5天CRP水平作为预测指标,AUC 0.759（95%CI：0.652-0.847）,以8.4 mg/dl作为切点值,敏感度80%,特异度76%,NPV 96%,PPV 31%。术后第5天PCT所做ROC曲线下面积大于CRP（Z=2.219,P=0.026）。结论 PCT与腔镜辅助下Mc Keown术式切除食管癌后吻合口瘘的发生具有相关性,可以作为吻合口瘘的早期辅助诊断手段。

Objective To assess the value of proca]eitonin （PCT） detection in the early diagnosis of anastomotic leak （ALs） and provide a new method for early diagnosis of ALs after MeKeown minimally invasive esophageetomy（MMIE） for esophageal cancer. Methods Between February 2011 and February 2013,82 cases of esophageal cancer underwent MMIE in our hospital were enrolled in this study, and were divided into AL group and non-AL group according to the occurrence of anastomotic leak. The levels of PCT and C-reactive protein（CRP） were detected on the first, third, and fifth day after the operations （Postoperative Day, POD）, and the postoperative complications were recorded. The receiver operat- ing characteristics （ROC） curves of PCT and CRP were conducted to identify the value of diagnosis. Results Among the 82 patients ,29 patients（35.4% ） were with postoperative complications. ALs was detected in 10 patients（ 12.2% ）. The area under the ROC curve for PCT in POD 5 was 0. 894（95% CI：0. 806 to 0.951 ） ,with a cutoff of 0.43 ng/ml,resuhing in a 100% sensitivity,74% specificity, 100% negative predictive value,and 34% positive predictive value. As for CRP, AUC in POD 5 was 0. 759（95% CI：0. 652 to 0.847） ,resulting in a 80% sensitivity,76% specificity,96% negative predictive value, and 31% positive predictive value. PCT has better area under the curve than CRP （Z = 2.219, P = 0. 026）. Conclusion There is a correlation between PCT levels and ALs after invasive esophagectomy for the esophageal cancer. PCT detection can improve the early diagnosis of ALs.