血清钠浓度与结直肠癌术后吻合口漏的相关性研究

Correlation between serum sodium concentration and anastomotic leakage after resection of colorectal cancer

目的探讨血清钠浓度在结直肠癌手术后吻合口漏发生的预测价值。方法回顾性分析2013年1月至2015年3月北京大学深圳医院胃肠外科行结直肠癌手术的546例病人的临床资料,将病人分为吻合口漏组(16例)和对照组(530例)。检测病人术前及术后第1、3、5、7天的钠离子([Na^+])、钙离子浓度([Ca^(2+)])和白蛋白(ALB)水平。先进行两组间单因素分析,而后进行多因素非条件Logistic逐步回归分析,筛选出有统计学意义的指标,并使用ROC曲线分析其预测病人吻合口漏发生的甄别阈值。结果吻合口漏组[Na^+]_3、[Na^+]_5、[Na^+]_7、[Ca^(2+)]_7、ALB_5、ALB_7的浓度低于对照组(P<0.05),差异有统计学意义。二项Logistic回归分析示,[Na^+]_3、[Na^+]_5和ALB_7入选回归方程。ROC曲线分析显示,[Na^+]_5≤135 mmol/L对结直肠癌术后发生吻合口漏有显著的诊断价值(AUC=0.901,P<0.001,灵敏度为93.75%,特异度为74.34%)。结论 [Na^+]_5浓度≤135mmol/L是敏感的预警指标,应该警惕吻合口漏发生的可能性,结合临床表现必要时行CT等检查明确诊断。

Objective To investigate the predictive value of serum sodium concentration in anas-tomotic leakage after resection of colorectal carcinoma.Methods A total of 546 patients with colorec-tal carcinoma admitted between January 2013 and March 2015 in Department of Gastrointestinal Sur-gery,Peking University Shenzhen Hospital were retrospectively identified.Patients were divided into anastomotic leakage group （n=16）and normal group （n=530）.[Na^＋],[Ca^2＋]and ALB were as-sessed preoperatively and on the 1st,3rd,5th and 7th day postoperatively.The single factor analysis was performed on all variables between the two groups,and then multi-factor binomial Logistic step-wise regression analysis was done.The statistically significant indexes were screened,and the ROC curve was used to analyze the threshold values of predicting anastomotic leakage.Results [Na^＋]3 , [Na^＋]5 ,[Na^＋]7 ,[Ca^2＋]7 ,ALB5 and ALB7 concentrations in anastomotic leakage group were signif-icantly lower than those in normal group （P〈0.05）.Three of variable [Na^＋]3 ,[Na^＋]5 and ALB7 were selected into Logistic regression analysis.The ROC analysis showed that [Na^＋]5 concentration≤135 mmol/L had highest predictive value （AUC=0.901,P〈0.001,93.75% sensitivity,74.34%specificity）.Conclusions Under [Na^＋]5 concentration ≤135 mmol/L,a sensitive early warning indi-cator,anastomotic leakage should be suspected and a CT scan with rectal contrast dye is recommen-ded.