外周血炎性指标与食管癌吻合口瘘发生的相关性

Correlation between peripheral blood inflammatory indexes and anastomotic fistula of esophageal cancer

目的分析外周血炎性指标与食管癌术后吻合口瘘的相关性以及在早期诊断中的价值。方法纳入123例2022年1月—2023年6月在兰州大学第二医院确诊并行食管癌根治术的患者,根据是否发生吻合口瘘将其分为正常组和吻合口瘘组,收集患者的一般资料和外周血炎性指标,采用单因素分析与多因素回归分析,探索炎性指标与吻合口瘘发生的相关性。结果123例患者中正常组104例,吻合口瘘组19例,吻合口瘘组的手术时间长于正常组,具有统计学意义(P<0.05);术前吻合口瘘组中的白细胞、中性粒细胞、中性粒细胞与淋巴细胞比值(NLR)、中性粒细胞与单核细胞比值(NMR)、全身免疫炎症指数(SII)均高于正常组,差异有统计学意义(P<0.05);术后1~3 d 2组患者的炎性指标差异无统计学意义(P>0.05);术后4~6 d吻合口瘘组患者NLR、血小板与淋巴细胞比(PLR)、SII显著高于正常组,而淋巴细胞、淋巴细胞与单核细胞比(LMR)低于正常组,差异有统计学意义(P<0.05);术后7 d之后两组患者的炎性指标差异有统计学意义(P<0.05),吻合口瘘组的白细胞、中性粒细胞、血小板、单核细胞、NLR、PLR、NMR、SII显著高于正常组,而淋巴细胞、LMR低于正常组。结论术前白细胞、中性粒细胞、NLR、NMR、SII处于高水平,与食管癌术后吻合口瘘的发生有一定的相关性,手术时间和术前NMR水平对吻合口瘘的发生有一定的预测作用;术后白细胞、中性粒细胞、SII下降缓慢,淋巴细胞数上升速度缓慢,血小板数上升速度快,提示发生吻合口瘘的可能性增加。

Objective To analyze the correlation between peripheral blood inflammatory index and anastomotic fistula after operation on esophageal cancer,and its value in early diagnosis.Methods A total of 123 patients diagnosed with esophageal cancer and having undergone radical resection of esophageal cancer in the Second Hospital of Lanzhou University from January 2022 to June 2023 were enrolled in the study.According to the presence or absence of anastomotic leakage,they were divided into a normal and an anastomotic leakage group.The general data and peripheral blood inflammatory indicators of the patients were collected,and univariate analysis and multivariate regression analysis used to explore the correlation between inflammatory indicators and anastomotic leakage.Results There were 104 cases in the normal group and 19 in the anastomotic leakage group.The operation time for the latter was longer than that for the former,with statistically significant difference(P<0.05).The white blood cells,neutrophils,NLR,NMR and SII in the preoperative anastomotic leak group were higher than those in the normal group,and the differences were statistically significant(P<0.05).There was no significant difference in inflammatory indexes between the two at 1-3 days after operation(P>0.05).The NLR,PLR and SII in the anastomotic leakage group were significantly higher,while the lymphocytes and LMR were lower,the differences being statistically significant(P<0.05).After 7 days,there were significant differences in inflammatory indexes between the two(P<0.05).White blood cells,neutrophils,platelets,monocytes,NLR,PLR,NMR,SII in the anastomotic leakage group were significantly higher than those in the normal group,while lymphocytes and LMR were lower than the normal group.Conclusion The high levels of preoperative white blood cell,neutrophil,NLR,NMR and SII were correlated with the occurrence of anastomotic leakage after esophageal cancer surgery.The operation time and preoperative NMR level had a certain predictive effect on the occurrence of anastomotic leakage.After operation,the number of white blood cells,neutrophils and SII would decrease slowly,the number of lymphocytes increase slowly,and the number of platelets increase rapidly,suggesting that the possibility of anastomotic leakage would increase.