Muneoka Yusuke, Ichikawa Hiroshi, Kosugi Shin-Ichi, Hanyu Takaaki, Ishikawa Takashi, Kano Yosuke, Shimada Yoshifumi, Nagahashi Masayuki, Sakata Jun, Kobayashi Takashi, Kameyama Hitoshi, Akazawa Kohei, Wakai Toshifumi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minamiuonuma-shi, Niigata, 949-7320, Japan.
Ann Med Surg (Lond). 2019 Feb 21;39:16-21. doi: 10.1016/j.amsu.2019.02.004. eCollection 2019 Mar.
Surgical stress and inflammation can cause hyperbilirubinemia, which sometimes occurs after esophagectomy for esophageal cancer (EC). The aim of this study was to elucidate the clinical significance of postoperative hyperbilirubinemia in the management of EC patients.
We retrospectively reviewed records of 81 EC patients who underwent esophagectomy from 2009 to 2014. We compared the clinicopathological and perioperative factors, including the presence of hyperbilirubinemia (total bilirubin ≥1.5 mg/dL), between patients with postoperative infectious complications (PIC group) and those without (Non-PIC group).
PIC developed in 52 patients (64.2%). There were significant differences in incidence of postoperative hyperbilirubinemia between the PIC group and the non-PIC group (34.6% vs. 3.4%, = 0.002), as well as the approach of esophagectomy ( = 0.045), the surgical duration (469 vs. 389 min, < 0.001), the amount of blood loss (420 vs. 300 mL, = 0.018), the frequency of intraoperative blood transfusions (32.7% vs. 6.9%, = 0.012) and the peak postoperative C-reactive protein level (17.3 vs. 8.6 mg/dL, = 0.007). Multivariate analysis revealed hyperbilirubinemia was independently associated with the occurrence of PICs (odds ratio: 38.6, = 0.010). The median time to the diagnosis of hyperbilirubinemia was significantly shorter than that of PICs (3.0 vs. 4.5 days, = 0.025).
Postoperative hyperbilirubinemia was associated with the occurrence of PICs and frequently occurred before any PICs become apparent. More attention should be paid to the serum bilirubin level in the management after esophagectomy for EC.
手术应激和炎症可导致高胆红素血症，食管癌（EC）食管切除术后有时会出现这种情况。本研究的目的是阐明术后高胆红素血症在EC患者管理中的临床意义。
我们回顾性分析了2009年至2014年接受食管切除术的81例EC患者的记录。我们比较了术后感染并发症患者（PIC组）和无并发症患者（非PIC组）的临床病理和围手术期因素，包括高胆红素血症（总胆红素≥1.5mg/dL）的存在情况。
52例患者（64.2%）发生了PIC。PIC组和非PIC组术后高胆红素血症的发生率存在显著差异（34.6%对3.4%，P=0.002），食管切除术的方式（P=0.045）、手术时间（469对389分钟，P<0.001）、失血量（420对300mL，P=0.018）、术中输血频率（32.7%对6.9%，P=0.012）以及术后C反应蛋白峰值水平（17.3对8.6mg/dL，P=0.007）也存在显著差异。多因素分析显示高胆红素血症与PIC的发生独立相关（优势比：38.6，P=0.010）。高胆红素血症诊断的中位时间明显短于PIC的诊断时间（3.0对4.5天，P=0.025）。
术后高胆红素血症与PIC的发生相关，且常在任何PIC出现之前频繁发生。在EC食管切除术后的管理中应更加关注血清胆红素水平。
