Zhang Guochao, Lian Rui, Sun Lichao, Liu Haibin, Wang Yan, Zhou Lei
Department of General Surgery, China-Japan Friendship Hospital, Beijing, China.
Department of Emergency Medicine, China-Japan Friendship Hospital, Beijing, China.
J Int Med Res. 2020 Aug;48(8):300060520950565. doi: 10.1177/0300060520950565.
Our objective was to investigate the association between anastomotic leakage (AL) and hyponatremia after colorectal cancer surgery.
All anastomoses in colorectal cancer surgery performed in our hospital between January 2015 and December 2017 were retrospectively identified. According to the diagnostic criteria of AL, the patients were divided into an AL group and a no anastomotic leakage (NAL) group.
We reviewed records of 498 consecutive colorectal cancer patients. The total incidence of AL was 5.4%. Postoperative serum sodium levels differed significantly: 137.63 ± 4.29 and 139.81 ± 3.41 mmol/L in the AL and NAL groups, respectively. By using area under the receiver-operating characteristic (auROC) curves, we determined the optimum postoperative serum sodium cut-off to be 139.5 mmol/L and redefined hyponatremia as postoperative serum sodium <139.5 mmol/L. Redefined hyponatremia had an auROC of 0.65, corresponding to a 97.2% negative predictive value. The negative predictive value reached 99.1% when serum sodium level was combined with leukocytosis. Multivariable analysis found that redefined hyponatremia (odds ratio, 1.176) was an independent predictive factor for AL.
Redefined hyponatremia has good negative predictive value for AL diagnosis after colorectal cancer surgery and could be used as a marker to exclude the diagnosis.
我们的目的是研究结直肠癌手术后吻合口漏（AL）与低钠血症之间的关联。
回顾性确定2015年1月至2017年12月在我院进行的结直肠癌手术中的所有吻合口。根据AL的诊断标准，将患者分为AL组和无吻合口漏（NAL）组。
我们回顾了498例连续结直肠癌患者的记录。AL的总发生率为5.4%。术后血清钠水平有显著差异：AL组和NAL组分别为137.63±4.29和139.81±3.41 mmol/L。通过受试者工作特征曲线下面积（auROC），我们确定术后血清钠的最佳截断值为139.5 mmol/L，并将低钠血症重新定义为术后血清钠<139.5 mmol/L。重新定义的低钠血症的auROC为0.65，对应97.2%的阴性预测值。当血清钠水平与白细胞增多症相结合时，阴性预测值达到99.1%。多变量分析发现，重新定义的低钠血症（优势比，1.176）是AL的独立预测因素。
重新定义的低钠血症对结直肠癌手术后AL诊断具有良好的阴性预测价值，可作为排除诊断的标志物。
