结直肠漏评分对直肠癌Dixon术后吻合口漏评估价值

Application of colorectal leak score in evaluating the anastomotic leakage after Dixon operation for rectal cancer

目的直肠癌主要的治疗方法为低位前切除(Dixon)术,但术后常易发生吻合口漏,且处理困难,较一般的并发症治疗过程长、耗费大。本研究探讨结直肠漏评分(colon leakage score,CLS)在评估直肠癌Dixon术后吻合口漏中的应用,以防治吻合口漏。方法选取2014-03-01-2018-03-01秦皇岛市第一医院直肠癌Dixon术患者150例,观察患者吻合口愈合情况,采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析CLS对直肠癌Dixon术后吻合口漏的评估价值。结果 150例患者中,吻合口漏有20例(13.33%)、无吻合口漏有130例(86.67%);吻合口漏患者CLS得分明显高于无吻合口漏患者,差异有统计学意义,t=23.778,P<0.05;ROC曲线结果显示,CLS得分以>11分时评估直肠癌Dixon术后吻合口漏的敏感度为95.00%,特异度为90.77%,准确度为91.33%,曲线下面积为0.902,一致性良好,K=0.836,P<0.05。结论 CLS可作为评估直肠癌Dixon术后吻合口漏的重要方法,其可为是否行预防性造瘘提供决策依据。

OBJECTIVE To discuss the application of colorectal leak score(CLS) in evaluating the anastomotic leakage after low anterior resection ( Dixon) operation for rectal cancer, in order to prevent the anastomotic leakage.METHODS Totally 150 patients with Dixon operation for rectal cancer were selected from March 1,2014 to March 1, 2018 in Qinhuangdao First Hospital, the anastomotic healing of patients were observed.the receiver operating characteristic( ROC) curve was used to analyze the value of CLS in evaluating anastomotic leakage after Dixon operation for rectal cancer.RESULTS Among the 150 patients in this study,there were 20 cases( 13.33%) of anastomotic fistula and 130 cases( 86.67%) without anastomotic fistula.The CLS score of patients with anastomotic fistula was significantly higher than that of patients without anastomotic fistula, the difference was statistically significant (t=23.778,PV0? 05).The ROC curve results showed that the sensitivity specificity, accuracy, area under the curve for evaluating the anastomotic leakage after Dixon operation for rectal cancer by CLS score as >11 score were 95.00%, 90.77 %, 91.33 %, 0.902, it had good consistency (K=0.836,P<0.05).CONCLUSIONS CLS can be used as the important method for evaluating anastomotic leakage after Dixon operation for rectal cancer,and it can provide a decision-making basis for whether to perform preventive stoma.