Riiskjær Mads, Forman Axel, Kesmodel Ulrik Schiøler, Andersen Lars Maagaard, Ljungmann Ken, Seyer-Hansen Mikkel
Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
Gynecol Obstet Invest. 2017;82(4):410-416. doi: 10.1159/000447513. Epub 2016 Jul 7.
The study aimed to assess the diagnostic value of serial monitoring of biochemical inflammatory markers (C-reactive protein (CRP) and white blood cell (WBC) count) in the postoperative diagnosis of anastomotic leakage or ureteral injury after bowel resection for deep infiltrating endometriosis.
This is a review of prospectively collected data from 217 patients who underwent laparoscopic bowel resection for endometriosis from January 2009 to April 2015. Patients with an anastomotic leakage or ureteral injury were identified and classified.
The frequency of anastomotic leakage requiring reoperation was 8.3%. The frequency of ureteral injury was 4.6%. Median time to diagnosis was 6 days for anastomotic leakage and 8 days for ureteral injury. The daily mean values of serum CRP were significantly higher in patients with a surgical complication starting at the second postoperative day (POD 2, p = 0.004). WBC was significantly higher (p < 0.05) on POD 2 and 3 in patients with a surgical complication. A decrease in CRP from POD 1 to 3 predicted an uncomplicated course in 92.1% of the cases.
A decrease in CRP from POD 1 to 3 was an indicator of uncomplicated subsequent postoperative course. The test is recommended when early discharge after rectal resection for deep infiltrating endometriosis is considered.
本研究旨在评估连续监测生化炎症标志物（C反应蛋白（CRP）和白细胞（WBC）计数）在深部浸润性子宫内膜异位症肠切除术后吻合口漏或输尿管损伤的术后诊断中的价值。
这是一项对2009年1月至2015年4月期间接受腹腔镜下子宫内膜异位症肠切除术的217例患者的前瞻性收集数据的回顾性研究。识别并分类发生吻合口漏或输尿管损伤的患者。
需要再次手术的吻合口漏发生率为8.3%。输尿管损伤发生率为4.6%。吻合口漏的中位诊断时间为6天，输尿管损伤为8天。从术后第二天（POD 2）开始，发生手术并发症的患者血清CRP的每日平均值显著更高（P = 0.004）。发生手术并发症的患者在POD 2和3时白细胞显著更高（P < 0.05）。从POD 1到3，CRP下降预测92.1%的病例术后过程无并发症。
从POD 1到3，CRP下降是术后后续过程无并发症的一个指标。当考虑对深部浸润性子宫内膜异位症进行直肠切除术后早期出院时，推荐进行该项检测。
