Hefler-Frischmuth Katrin, Lafleur Judith, Brunnmayr-Petkin Gudrun, Roithmeier Franz, Unterrichter Verena, Hefler Lukas, Tempfer Clemens
Department of Internal Medicine I, Ordensklinikum Linz, Seilerstätte 4, 4020, Linz, Austria.
Department of Gynecology, Ordensklinikum Linz, Linz, Austria.
Arch Gynecol Obstet. 2017 Aug;296(2):285-293. doi: 10.1007/s00404-017-4440-7. Epub 2017 Jun 19.
To evaluate published evidence in the literature on compartment syndrome (CS) in association with gynecologic surgery and to establish postoperative normal values for serum creatine kinase (CK) and myoglobin.
The present study consists of a case report of a patient with CS, a systematic review including 37 studies and 86 patients with CS, and a retrospective cohort study of 300 patients undergoing various types of laparoscopy for benign or malignant diseases in order to establish postoperative normal values.
We report on a patient with early-stage ovarian cancer, who developed CS after laparoscopic surgery with massively elevated serum CK and myoglobin levels, i.e., 1109 U/L and 18151 µg/L, respectively. In our systematic review, median serum CK and myoglobin levels among women with CS were 19,223 (177-27,412) U/L and 1248 (285-1360) µg/L, respectively. In our cohort study, the median postoperative serum CK and myoglobin levels were 68 (14-1576) U/L and 45 (14-1040) µg/L, respectively. The 95th and 99th percentile of serum CK and myoglobin levels were 158 and 391.5 U/L, and 152.3 and 298.9 µg/L, respectively.
Markedly elevated postoperative serum levels of CK and myoglobin levels might raise the suspicion for CS and could therefore aid in the rapid diagnosis of CS.
评估文献中关于妇科手术相关骨筋膜室综合征（CS）的已发表证据，并确定血清肌酸激酶（CK）和肌红蛋白的术后正常参考值。
本研究包括1例CS患者的病例报告、一项纳入37项研究和86例CS患者的系统评价，以及一项对300例因良性或恶性疾病接受各种腹腔镜手术患者的回顾性队列研究，以确定术后正常参考值。
我们报告了1例早期卵巢癌患者，该患者在腹腔镜手术后发生CS，血清CK和肌红蛋白水平大幅升高，分别为1109 U/L和18151 μg/L。在我们的系统评价中，CS女性患者血清CK和肌红蛋白水平的中位数分别为19223（177 - 27412）U/L和1248（285 - 1360）μg/L。在我们的队列研究中，术后血清CK和肌红蛋白水平的中位数分别为68（14 - 1576）U/L和45（14 - 1040）μg/L。血清CK和肌红蛋白水平的第95和第99百分位数分别为158和391.5 U/L，以及152.3和298.9 μg/L。
术后血清CK和肌红蛋白水平显著升高可能提示CS，因此有助于CS的快速诊断。
