左半结肠术后吻合口漏预测评分系统在腹腔镜直肠癌手术中的应用价值

Application of colon leakage score in laparoscopic anterior resection for rectal cancer

目的探讨左半结肠术后吻合口漏评分系统(CLS)在腹腔镜直肠癌前切除术中的应用价值。方法回顾性分析2014年1月至2016年12月268例接受腹腔镜直肠癌前切除术且未行术中预防性肠造瘘患者的临床资料。采用ROC曲线评价CLS的预测价值。logistic回归评估CLS评分,计算CLS评分对应吻合口漏发生概率。结果 268例腹腔镜直肠癌前切除术患者吻合口漏发生率为5.6%(15/268)。CLS评分在发生吻合口漏组(12.93±2.12)与未发生吻合口漏组(9.68±3.05)比较差异有统计学意义(P<0.01)。CLS预测吻合口漏的AUC是0.823(95%CI:0.733~0.913),OR=1.37(95%CI:1.16~1.62,P<0.01)。CLS=11分是预测界点,对吻合口漏的预判灵敏度为93.3%,特异度为66.0%。结论 CLS能够预测腹腔镜直肠癌前切除术后吻合口漏风险,为术中是否行肠造瘘提供决策依据。

Objective To assess the application of the colon leakage score （CLS） in predicting the risk of anastomotic leakage （AL） after laparoscopic anterior resection for rectal cancer.Methods Clinical data of 268 patients with rectal cancer undergoing laparoscopic anterior resection between January 2014 and December 2016 were retrospectively reviewed.The predictive value of CLS was assessed by receiver operating characteristic curve （ROC）.Logistic regression analysis was performed to determine the correlation between the CLS and the occurrence of AL.The predicted probability of AL per CLS value was calculated.Results Among 268 patients,the rate of anastomotic leakage was 5.6%（15/268）.The mean CLS in the leakage group was 12.93 ± 2.12 versus 9.68 ± 3.05 in the non-leakage group （P〈0.01）.The area under the ROC curve （AUC） was 0.823 （95%CI：0.733-0.913）.Logistic regression analysis showed an odds ratio （OR） of 1.37（95%CI：1.16-1.62,P〈0.01）.Both of AUC and OR indicated that the CLS was a predictor of anastomotic leakage.A CLS of 11 was used for cutoff value,with a sensitivity and specificity of 93% and 66%,respectively.Conclusion The CLS can be used to predict the risk of anastomotic leakage after laparoscopic anterior resection for rectal cancer and it may provide an indicator for clinical decision of enterostomy.