C反应蛋白对开腹与腹腔镜行胃肠癌手术术后感染的预测

C-reactive protein for predicting postoperative infection after open versus laparoscopic surgery for gastrointestinal carcinoma

目的探讨C反应蛋白(CRP)预测开腹与腹腔镜行胃肠癌手术合并术后感染诊断准确性。方法选取2014年12月至2017年1月于中国医科大学附属第一医院胃肠肿瘤外科接受胃肠癌手术的354例患者作为研究对象,根据手术方式将其分为开腹组和腹腔镜组。术后5 d常规检测血清CRP水平,通过分析对比及绘制受试者工作特征(ROC)曲线得出相应结论。结果 ROC曲线分析表明,术后4 d的CRP水平预测开腹组术后感染的诊断准确性最高(AUC=0.740),敏感度为60.5%,特异度为80.0%,最佳临界值(cut-off)为112.50 mg/L。术后2 d的CRP水平预测腹腔镜组术后感染的诊断准确性最高(AUC=0.860),敏感度为78.6%,特异度为80.9%,最佳临界值(cut-off)为142.50 mg/L。结论术后CRP水平预测腹腔镜行胃肠癌根治术术后感染的准确性更优于传统的开腹手术,且腹腔镜手术术后2 d的CRP水平若大于142.50 mg/L,应警惕术后感染性并发症的发生。

Objective To compare the accuracy of C-reactive protein(CRP)in predicting postoperative infective complications after open versus laparoscopic surgery for gastrointestinal carcinoma.Methods During the period from December 2014 to January 2017,354 patients with gastrointestinal cancer who underwent surgery at the First Hospital of China Medical University were included and divided into either an open surgery group or a laparoscopic surgery group according to operation method.Serum CRP levels were detected routinely from postoperative day(POD)1 to POD 5,and receiver operating characteristic(ROC)curve analysis was performed to assess the accuracy of CRP in predicting postoperative infective complications in the two groups.Results ROC curve analysis showed that CRP level on POD 4 had the highest accuracy in predicting postoperative infection in the open surgery group(AUC=0.740),yielding a sensitivity of 60.5%and a specificity of 80.0%,at the best threshold(cut-off)of 112.50 mg/L.In the laparoscopic surgery group,CRP level on POD 2 had the highest accuracy in predicting postoperative infective complications(AUC=0.860),with a sensitivity of 78.6%and a specificity of 80.9%,at the best threshold(cut-off)of 142.50 mg/L.Conclusion The accuracy of CRP level for predicting postoperative infection after laparoscopic surgery for gastrointestinal carcinoma is superior to that after traditional open surgery,and the development of postoperative infective complications should be suspected when CRP is>142.50 mg/L on day 2 after laparoscopic surgery.