Prochazka Vladimir, Marek Filip, Kunovsky Lumir, Svaton Roman, Farkasova Martina, Potrusil Martin, Moravcik Petr, Kala Zdenek
Department of Surgery, Faculty of Medicine, University Hospital Brno Bohunice, Masaryk University, Brno, Czech Republic.
Department of Surgery; Department of Gastroenterology, Faculty of Medicine, University Hospital Brno Bohunice, Masaryk University, Brno, Czech Republic.
J Minim Access Surg. 2019 Jan-Mar;15(1):46-50. doi: 10.4103/jmas.JMAS_254_17.
Anastomotic leaks after oesophagectomy with tabularised stomach replacement are a significant factor in post-operative mortality and morbidity. Early detection and treatment of this complication allow for improving operative and oncological results. When assessing laboratory values - elevation of inflammatory parameters - complicated interpretation is an issue (systemic inflammatory response syndrome, surgical versus non-surgical complication). Results studying the relationship between C-reactive protein (CRP) and complications following oesophagectomies are inconsistent. The aim of our work was to find relationships between the development of post-operative CRP values and the occurrence of anastomotic complications following minimally invasive oesophagectomy (MIE).
Analysis of the relationship between CRP values and the occurrence of anastomotic complications or the necessity of reoperation following oesophagectomy with tabularised stomach replacement and cervical anastomosis performed using thoracoscopy and laparoscopy in a group of patients operated on for malignancies at our department between 2012 and 2015.
A significant difference was found in average CRP values on the 5 day and 7 day following operation between patients with and without leaks (233 mg/l vs. 122.8 mg/l P = 0.003, respectively 208.9 mg/l vs. 121.3 mg/l P = 0.014). However, on the 5 day, the leak was clinically apparent only in one case out of 11 leaks. A significant difference in CRP values on the 5 day was found between patients who needed revision surgery and patients without revision surgery (294 mg/l vs. 133.5 mg/l P = 0.01).
Patients after MIE with tabularised stomach replacement and cervical anastomosis complicated by anastomotic leaks or with the necessity for reoperation had a significantly higher CRP values on the 5 day following operation than patients without complications, regardless of the presence of clinical signs of leaks.
采用胃成形术替代食管进行食管切除术后的吻合口漏是术后死亡率和发病率的一个重要因素。早期发现和治疗这种并发症有助于改善手术和肿瘤治疗效果。在评估实验室值（炎症参数升高）时，复杂的解读是一个问题（全身炎症反应综合征、手术与非手术并发症）。研究C反应蛋白（CRP）与食管切除术后并发症之间关系的结果并不一致。我们研究的目的是找出微创食管切除术（MIE）后术后CRP值的变化与吻合口并发症发生之间的关系。
分析2012年至2015年在我院接受恶性肿瘤手术的一组患者中，采用胸腔镜和腹腔镜进行胃成形术替代食管并进行颈部吻合的食管切除术后CRP值与吻合口并发症发生或再次手术必要性之间的关系。
有漏和无漏患者术后第5天和第7天的平均CRP值存在显著差异（分别为233mg/L对122.8mg/L，P = 0.003；208.9mg/L对121.3mg/L，P = 0.014）。然而，在第5天，11例漏病例中只有1例临床上明显出现漏。需要翻修手术的患者与无需翻修手术的患者在术后第5天的CRP值存在显著差异（294mg/L对133.5mg/L，P = 0.01）。
采用胃成形术替代食管并进行颈部吻合的MIE术后患者，若发生吻合口漏或有再次手术的必要，无论是否有漏的临床体征，术后第5天的CRP值均显著高于无并发症的患者。
