Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, University of Auckland, Auckland, New Zealand.
Department of Surgery, University of Auckland, Auckland, New Zealand.
Br J Surg. 2017 Apr;104(5):503-512. doi: 10.1002/bjs.10487.
Anastomotic leakage (AL) following colorectal surgery can be difficult to diagnose owing to varying clinical presentations. This systematic review aimed to assess biomarkers as potential diagnostic tests for preclinical detection of AL.
A comprehensive literature review was conducted according to PRISMA guidelines. All published studies evaluating biomarkers, both systemic and peritoneal, in the context of AL following colorectal surgery were included. Studies were sought in three electronic databases (MEDLINE, PubMed and Embase) from January 1990 to June 2016.
Thirty-six studies evaluated 51 different biomarkers in the context of AL after colorectal surgery. Biomarkers included markers of ischaemia and inflammation, and microbiological markers, and were measured in both peritoneal drain fluid and the systemic circulation. The most commonly evaluated peritoneal drain fluid biomarkers were interleukin (IL) 6, IL-10 and tumour necrosis factor. Significantly raised drain levels in the early postoperative period were reported to be associated with the development of AL. C-reactive protein, procalcitonin and leucocytes were the most commonly evaluated systemic biomarkers with significant negative and positive predictive values. Associated area under the curve values ranged from 0·508 to 0·960.
Peritoneal drain fluid and systemic biomarkers are poor predictors of AL after colorectal surgery. Combinations of these biomarkers showed improvement in predictive accuracy.
由于临床表现各异，结直肠手术后吻合口漏（AL）的诊断较为困难。本系统评价旨在评估生物标志物作为 AL 临床前检测的潜在诊断试验。
根据 PRISMA 指南进行全面的文献检索。纳入所有评估结直肠手术后生物标志物（包括系统和腹膜内）与 AL 相关性的已发表研究。研究时间为 1990 年 1 月至 2016 年 6 月，检索了 3 个电子数据库（MEDLINE、PubMed 和 Embase）。
36 项研究评估了 51 种不同的生物标志物在结直肠手术后 AL 中的应用。生物标志物包括缺血和炎症标志物，以及微生物标志物，分别测量了腹膜引流液和全身循环中的标志物。最常评估的腹膜引流液生物标志物是白细胞介素（IL）6、IL-10 和肿瘤坏死因子。研究报道，术后早期引流液中这些标志物的水平显著升高与 AL 的发生有关。C 反应蛋白、降钙素原和白细胞是最常评估的全身生物标志物，具有显著的阴性和阳性预测值。相关曲线下面积值范围为 0.508 至 0.960。
腹膜引流液和全身生物标志物对结直肠手术后 AL 的预测作用较差。这些生物标志物的组合可提高预测准确性。
