Binnebösel Marcel, Schuler Tim, Klink Christian D, Busch Daniel, Schöb Dominik S, von Trotha Klaus T, Neumann Ulf P, Junge Karsten
Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany,
Int J Colorectal Dis. 2014 Jun;29(6):681-8. doi: 10.1007/s00384-014-1855-5. Epub 2014 Apr 13.
The aim of this prospective study was to evaluate the predictive value of a potential preexisting low-grade inflammation regarding the incidence of anastomotic leakage in elective laparoscopic sigmoid resection due to diverticulitis.
Patients with either chronically recurrent diverticulitis or sigmoid stenosis caused by chronic diverticulitis were included in this study. All patients with acute local or systemic inflammation were excluded. Detailed patient information (e.g. American Society of Anesthesiologists (ASA) grade, comorbidities, duration of hospital stay, and anastomotic leakage) was prospectively recorded. CD68(+) macrophages, neutrophils, CD3(+) T-lymphocytes, CD11c(+) dendritic cells, MHCII, TNFR1, and NF-κB were evaluated by immunohistochemistry within the acquired sample of colonic bowel wall tissue. Clinical and immunohistochemical data was compared between groups (leakage vs. no leakage). Additionally, a matched-pair analysis was performed due to the widely heterogeneous groups concerning the number of patients and to minimize the effect of extraneous variables.
A total of 83 patients were included in the study, of which 7 patients suffered an anastomotic leakage. Neither the clinical nor the immunohistochemical parameters were significantly different between the groups. The matched-pair analysis revealed a nonsignificant increase in mean duration of hospital stay for the group with anastomotic leakage and a significantly higher percentage of CD68(+) macrophages and neutrophils in the colonic wall obtained at the index operation in both the mucosal and submucosal layers for the leakage group.
A preexisting low-grade inflammation represented by infiltrates of macrophages and neutrophils is a predictor for increased risk of developing colon anastomotic leakage.
这项前瞻性研究的目的是评估潜在的既往存在的低度炎症对因憩室炎行择期腹腔镜乙状结肠切除术吻合口漏发生率的预测价值。
本研究纳入患有慢性复发性憩室炎或由慢性憩室炎引起的乙状结肠狭窄的患者。排除所有有急性局部或全身炎症的患者。前瞻性记录详细的患者信息（如美国麻醉医师协会（ASA）分级、合并症、住院时间和吻合口漏情况）。通过免疫组织化学对获取的结肠肠壁组织样本中的CD68(+)巨噬细胞、中性粒细胞、CD3(+) T淋巴细胞、CD11c(+)树突状细胞、MHCII、TNFR1和NF-κB进行评估。比较两组（有漏与无漏）的临床和免疫组织化学数据。此外，由于患者数量差异很大的组间存在广泛异质性，为尽量减少外部变量的影响，进行了配对分析。
本研究共纳入83例患者，其中7例发生吻合口漏。两组之间的临床和免疫组织化学参数均无显著差异。配对分析显示，吻合口漏组的平均住院时间无显著增加，漏组在初次手术时获取的结肠壁黏膜层和黏膜下层中，CD68(+)巨噬细胞和中性粒细胞的百分比显著更高。
以巨噬细胞和中性粒细胞浸润为代表的既往存在的低度炎症是结肠吻合口漏发生风险增加的一个预测因素。
