Dusek Tomas, Orhalmi Julius, Sotona Otakar, Krcmova Lenka Kujovska, Javorska Lenka, Dolejs Josef, Paral Jiri
Department of Surgery, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic.
Department of Military Surgery, Faculty of Military Health Sciences in Hradec Kralove, University of Defence in Brno, Czech Republic.
Wideochir Inne Tech Maloinwazyjne. 2018 Mar;13(1):44-52. doi: 10.5114/wiitm.2018.73363. Epub 2018 Feb 7.
At present, there are no strong predictors, nor a useful scoring system, that clearly identifies patients at risk for anastomotic leakage.
This study aimed to investigate a new method that assesses this risk by monitoring levels of neopterin, tryptophan, and kynurenine, in bodily fluids.
This prospective study included patients who underwent elective rectal resection for carcinoma. The basic condition for inclusion was rectal anastomosis using the double-stapling technique. Preoperative levels of neopterin, tryptophan, kynurenine, and their ratios, were assessed with blood and urine samples. These levels were then monitored for 6 postoperative days in venous blood, urine, and abdominal drainage fluid.
A total of 42 patients were enrolled in the study. Thirty-six patients underwent a laparoscopic resection and 6 patients had an open procedure. No differences were found among neopterin, tryptophan, and kynurenine serum levels. However, the groups were observed to have significant differences in the urinary neopterin/creatinine ratio: the preoperative neopterin/creatinine ratio was 139.5 μmol/mol in the group with leakage, vs 114.8 μmol/mol in the group without complications, p = 0.037. The same results were observed during the postoperative period, p = 0.012. Additionally, the group with complications had a higher mean value of neopterin in drainage fluid, p = 0.048.
Our study demonstrated that high preoperative levels of urinary neopterin could be interpreted as a risk for anastomotic leakage. Moreover, pathological levels of neopterin in urine and abdominal drainage fluid could be useful for early identification of anastomotic leakage during the postoperative period prior to its clinical development.
目前，尚无强有力的预测指标，也没有实用的评分系统能够明确识别有吻合口漏风险的患者。
本研究旨在探讨一种通过监测体液中蝶呤、色氨酸和犬尿氨酸水平来评估这种风险的新方法。
这项前瞻性研究纳入了因癌症接受择期直肠切除术的患者。纳入的基本条件是采用双吻合器技术进行直肠吻合。术前通过血液和尿液样本评估蝶呤、色氨酸、犬尿氨酸及其比值的水平。然后在术后6天对静脉血、尿液和腹腔引流液中的这些水平进行监测。
共有42例患者纳入本研究。36例患者接受了腹腔镜切除术，6例患者接受了开放手术。蝶呤、色氨酸和犬尿氨酸的血清水平在各组之间未发现差异。然而，观察到各组在尿蝶呤/肌酐比值上存在显著差异：发生吻合口漏的组术前蝶呤/肌酐比值为139.5μmol/mol，无并发症组为114.8μmol/mol，p = 0.037。术后期间观察到相同结果，p = 0.012。此外，有并发症的组引流液中蝶呤的平均值更高，p = 0.048。
我们的研究表明，术前尿蝶呤水平升高可被视为吻合口漏的风险因素。此外，尿液和腹腔引流液中蝶呤的病理水平对于在术后临床症状出现之前早期识别吻合口漏可能有用。
