Keramidaris D, Koronakis N, Lagoudianakis E E, Pappas A, Koukoutsis I, Chrysikos I, Karavitis G, Toutouzas K, Manouras A
Second Department of Surgery, 401 Army General Hospital, Athens, Greece.
J BUON. 2013 Jul-Sep;18(3):623-8.
Bacterial translocation (BT) is common in colon cancer patients and may be associated with increased occurrence of septic complications as well as with adverse oncologic outcomes. The aim of the present study was to correlate the BT detectable through peritoneal lavage culture or identified by abnormal inflammatory parameters with the clinicopathologic parameters and the short-term prognosis in a prospective series of patients.
Fifty-four consecutive patients with histologically proven colorectal cancer were included in this prospective study. White blood cells (WBC), erythrocyte sedimentation rate (ESR) and serum levels of procalcitonin (PCT) and C-reactive protein (CRP) were determined and cultures from peritoneal lavage were collected immediately after laparotomy.
Positive PCT was detected in 31 (55.3%) patients while positive cultures were obtained in 6 (11%) patients. Significant positive correlation of PCT with inflammation markers was noticed. Patients with distant metastases had higher serum PCT levels than patients without distant metastases (p=0.01). Borderline statistical significance was found between PCT and tumor grade (p=0.09). PCT was not correlated with the cultures of the lavage or the outcome.
PCT is an adequate inflammatory marker, able to preoperatively discriminate patients with bacterial systemic inflammatory reaction due to BT. However, the clinical consequence of BT may be minimal as is shown by the lack of association of PCT or positive peritoneal lavage cultures with time to discharge, complications and short-term survival.
细菌移位（BT）在结肠癌患者中很常见，可能与脓毒症并发症发生率增加以及不良肿瘤学结局有关。本研究的目的是在前瞻性系列患者中，将通过腹腔灌洗培养检测到的或由异常炎症参数确定的BT与临床病理参数及短期预后相关联。
本前瞻性研究纳入了54例经组织学证实为结直肠癌的连续患者。测定白细胞（WBC）、红细胞沉降率（ESR）以及降钙素原（PCT）和C反应蛋白（CRP）的血清水平，并在剖腹手术后立即收集腹腔灌洗的培养物。
31例（55.3%）患者检测到PCT阳性，6例（11%）患者培养结果为阳性。注意到PCT与炎症标志物之间存在显著正相关。有远处转移的患者血清PCT水平高于无远处转移的患者（p = 0.01）。PCT与肿瘤分级之间存在边缘统计学意义（p = 0.09）。PCT与灌洗培养结果或结局无关。
PCT是一种合适的炎症标志物，能够在术前区分因BT引起细菌全身性炎症反应的患者。然而，BT的临床后果可能微乎其微，因为PCT或腹腔灌洗培养阳性与出院时间、并发症及短期生存之间缺乏关联。
