术前血清C反应蛋白对肠皮肤瘘确定性手术修复后复发的预测价值

Predictive value of preoperative serum C-reactive protein for recurrence after definitive surgical repair of enterocutaneous fistula.

作者信息

Martinez Jose L, Luque-de-León Enrique, Ferat-Osorio Eduardo, Estrada-Castellanos Alicia

机构信息

Department of General and Gastrointestinal Surgery, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI (IMSS), Av. Cuauhtémoc 330. 3er. Piso, Servicio de Gastrocirugìa, Colonia Doctores, Del. Cuauhtémoc, México DF, CP 06725, México.

出版信息

Am J Surg. 2017 Jan;213(1):105-111. doi: 10.1016/j.amjsurg.2016.05.008. Epub 2016 Jun 16.

DOI:10.1016/j.amjsurg.2016.05.008

PMID:27394064

Abstract

BACKGROUND

Recurrence rates after surgical repair of enterocutaneous fistula (ECF) have not changed substantially. Serum C-reactive protein (s-CRP) has been used as an indicator of postoperative complications in abdominal surgery. The aim of this study was to determine the predictive value of preoperative s-CRP for recurrence after definitive surgical repair of ECF.

METHODS

Fifty consecutive patients with ECF persistence submitted electively to definitive surgical repair (ECF resection with primary anastomosis) were included. Among several variables, preoperative s-CRP (primary independent variable) was assessed as a factor related to recurrence (dependent variable). Univariate and multivariate analyses were performed.

RESULTS

ECF recurred in 19 patients (38%). Univariate and multivariate analyses disclosed operative blood loss greater than 325 mL (P < .05) and preoperative s-CRP greater than .5 mg/dL (P < .01) as the only risk factors for recurrence. ECF recurrence rates were significantly higher for patients with preoperative s-CRP above this level (53% vs 11%, P < .01). After conservative and surgical management, overall ECF closure was attained in 40 patients (80%).

CONCLUSIONS

Our results suggest that s-CRP may serve as a useful parameter to predict potential failure (recurrence) in patients submitted to definitive closure of ECF.

摘要

背景

肠造口瘘（ECF）手术修复后的复发率并未有显著变化。血清C反应蛋白（s-CRP）已被用作腹部手术术后并发症的一项指标。本研究的目的是确定术前s-CRP对ECF确定性手术修复后复发的预测价值。

方法

纳入连续50例择期接受确定性手术修复（ECF切除并一期吻合）的持续性ECF患者。在多个变量中，术前s-CRP（主要自变量）被评估为与复发（因变量）相关的一个因素。进行了单因素和多因素分析。

结果

19例患者（38%）出现ECF复发。单因素和多因素分析显示，手术失血量大于325 mL（P <.05）和术前s-CRP大于0.5 mg/dL（P <.01）是复发的唯一危险因素。术前s-CRP高于此水平的患者ECF复发率显著更高（53%对11%，P <.01）。经过保守治疗和手术处理，40例患者（80%）实现了ECF的总体闭合。