| Objective This study intends to screen out the accurate and practical indicators for early diagnosis of anastomotic leakage after rectal anterior resection of rectal cancer from some clinically used observation indicators and laboratory indicators,to provide a basis for early clinical judgment and intervention of anastomotic leakage.Methods A total of 128 patients with rectal cancer who underwent rectal anterior resection in the Department of Colorectal and Anal Surgery at the 940th Hospital of Joint Service Support Force from September 2017 to January 2019 were included in the study.The128 patients were divided into anastomotic hernia group and no anastomotic leakage group.The anastomotic leakage group included 16 patients with anastomotic leakage diagnosed by postoperative imaging,colonoscopy,or surgical exploration.The no anastomotic leakage group was the remaining 112 patients who did not have anastomotic leakage.General data were collected from 128 patients,and abdominal drainage,body temperature,activated partial thromboplastin time,fibrinogen,D-dimer,white blood cell count,hemoglobin,percentage of neutrophils,platelets,C-reactive protein,procalcitonin,interleukin-6,prealbumin,albumin,serum potassium,serum sodium,and blood glucose were continuously monitored in all patients 1-7 days after surgery.The anastomosis was assessed on the 3rd and 5th postoperative days using pelvic CT or MRI.A pelvic CT or MRI was performed in time for patients with obvious clinical symptoms.X-ray angiography was performed on patients with clinically significant symptoms but whose pelvic CT or MRI did not clearly diagnose anastomotic leakage.The incidence of anastomotic leakage and the mean time to diagnose an anastomotic fistula were calculated.Use the?~2 test or Fisher's exact probability method to determine the relationships between patient's gender,age,presence or absence of diabetes,history of abdominal surgery,surgical procedure,intraoperative blood transfusion,preoperative stoma,tumor location,postoperative pathological staging and anastomosis was analyzed by univariate analysis.Using the?~2 test or Fisher's exact probability method,to analyse the associations between the patient's gender,age,history of diabetes,history of abdominal surgery,surgical procedure,intraoperative blood transfusion,intraoperative ostomy,tumor location,postoperative pathological staging and anastomotic leakage,respectively.The difference between hospitalization expenses and hospitalization time between the two groups was analyzed by nonparametric test.Differences in the above 17indicators collected between the two groups of patients on days 1-7 after surgery were analyzed using an independent sample T test or a non-parametric test.The value of indicators with significant differences and the combined multi-indexs in early diagnosis of anastomotic leakage was evaluated by the area under the receiver operating characteristic curve,sensitivity,specificity,negative predictive rate,positive predictive rate and optimal cut-off value.Results 1.128 patients were included in the study,of which 16 patients developed anastomotic leakage,112 patients did not have anastomotic leakage,and the incidence of anastomotic leakage was 12.5%.The average time to develop anastomotic leakage was 6.06days.No deaths.2.There were 63 cases of tumor location?7cm from the anal margin,including 12 cases of anastomotic leakage.There were 64 cases of tumor location>7cm from the anal margin,including 4 cases of anastomotic leakage.Univariate analysis showed that the incidence of anastomotic leakage was significantly higher in patients with a tumor location?7cm from the anal margin than in patients with anal margin>7 cm(P=0.029).3.The hospitalization cost of patients with anastomotic fistula was between 68419.93-129059.76yuan,the median was 91686.36 yuan;the hospital stay was between 19-66 days,and the median was 31 days.The hospitalization cost of patients with non-anastomotic fistula was between 49976.3-123558.81 yuan,the median was 70659.26 yuan;the hospital stay was between 11-67 days,and the median was 16 days.The hospitalization cost of patients with anastomotic hernia was significantly higher than that of patients with non-anastomotic hernia(P<0.01);the hospitalization days of patients with anastomotic leakage were significantly higher than those of patients without anastomotic leakage(P<0.01).4.The 17 indicators monitored from 1-7 days after operation were compared between groups.The results showed that there was no significant difference between the indexes of patients with anastomotic leakage and patients with non-anastomotic fistula on the 1st and 2nd day after operation(P?0.05).C-reactive protein,procalcitonin,interleukin-6,white blood cells,and percentage of neutrophils were significantly higher in patients with anastomotic leakage than those without anastomotic leakage on the 3-5th day after surgery(The P values on the third day after surgery were 0.013,0.012,<0,01,0.009,0.029,respectively.The P values on the fourth day after surgery were 0.007,0.038,0.020,0.012,0.073,respectively.The P values on the fifth day after surgery were 0.035,0.013,0.008,0.013,<0.01,respectively).The serum albumin and prealbumin levels measured on the 5th postoperative day of patients with anastomotic leakage were lower than those of patients without anastomotic leakage(P values:0.033,0.039,respectively).The white blood cell count and the percentage of neutrophils measured on the6th postoperative day of patients with anastomotic leakage were significantly higher than those of patients without anastomotic leakage(P values:0.023,0.033,respectively).Prealbumin levels measured on day 6 postoperatively in patients with anastomotic leakage were significantly lower than those in patients without anastomotic leakage(P=0.037).The receiver operating characteristic curve was used to analyze the diagnostic value of C-reactive protein,procalcitonin,interleukin-6,white blood cell count and neutrophil percentage measured on the 3-5th postoperative day.The results showed that all the areas under the receiver operating characteristic curve of the above indicators were>0.5(the third day after surgery were:0.70,0.70,0.84,0.71,0.67;the fourth day after surgery:0.74,0.68,0.71,0.75,0.70;the fifth day after surgery were 0.71,0.70,0.72,0.73,0.84,respectively).On the 5th day after surgery,the area under the working characteristic curve of albumin and prealbumin was>0.5(0.67,0.73,respectively).Although there were significant differences in prealbumin,white blood cell count,and neutrophil percentage measured on day 6 after surgery,the mean time to diagnose anastomotic leakage was 6.06 days,so no further statistical analysis was performed.6.On the third day after operation,the area under the working characteristic curve of interleukin-6 was the largest(0.84),the corresponding critical value was 42.2pg/ml,the sensitivity was 81.3%,the specificity was 84.32%,and the positive predictive rate was Up to42.52%,the negative predictive rate was 96.93%.On the 4th day after surgery,the area under the working characteristic curve of the white blood cell count was the largest(0.75),the corresponding critical value was 6.88×10~9/L,the sensitivity was 92.9%,the specificity was47.12%,the positive predictive rate was 20.10,and the negative predictive rate was 97.89%.On the 5th day after operation,the area under the working characteristic curve of the neutrophil percentage was the largest(0.84),the corresponding critical value was 79.45%,the sensitivity was 85.4%,the specificity was 80.42%,the positive predictive rate was 38.37%,and the negative prediction rate was 97.47%.7.Using the receiver's operating characteristic curve,the indicators with significant differences on the 3rd,4th,and 5th postoperative days were analyzed.The results showed that the area under the working characteristic curve of the multiple indicators combined monitoring on the 3rd,4th,and 5th postoperative days were0.86,0.87,and 0.90,respectively,which were larger than the area under the receiver operating characteristic curve of each single index on the same day.On the 5th day after operation,the area under the working characteristic curve of the combined index was the largest(0.90),the corresponding sensitivity was 75.0%,the specificity was 91.6%,the positive predictive rate was 56.05%,and the negative predictive rate was 96.25%.Conclusion 1.C-reactive protein,procalcitonin,interleukin-6,WBC count and neutrophil percentage measured on the 3-5th days after surgery,albumin and prealbumin measured on the 5th day after surgery were valuable for the early diagnosis of anastomotic leakage after pre-rectal resection in rectal cancer patients.Among the indicators measured on the third day after surgery,interleukin has the highest diagnostic value.Among the indicators measured on the fourth day after surgery,the diagnostic value of C-reactive protein and white blood cell count was the highest.And among the indicators measured on the fifth day after surgery,the percentage of neutrophils was the most diagnostic.The diagnostic value of prealbumin and albumin measured on the 5th day after surgery cannot be ignored.2.The diagnostic value of multi-index combined monitoring for anastomotic leakage after rectal anterior resection of rectal cancer was higher than each single index on the same day.Among them,the multi-index combined measurement on the 5th day after operation has the highest diagnostic value,which can diagnose the anastomotic leakage more accurately.It is recommended to detect C-reactive protein,procalcitonin,interleukin-6,white blood cell count and neutrophil percentage on the 3rd and 4th postoperative day,and detect C-reactive protein,procalcitonin,interleukin-6,white blood cell count,percentage of neutrophils,albumin and prealbumin on the 5th day after surgery,which is helpful for early detection of anastomotic leakage and guiding early clinical intervention. |
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