Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Rev Gastroenterol Mex (Engl Ed). 2021 Jul-Sep;86(3):229-235. doi: 10.1016/j.rgmxen.2021.05.003. Epub 2021 May 14.
Total gastrectomy is utilized in different pathologies. Esophagojejunostomy leakage is a frequent complication. Our aim was to determine the association of the neutrophil-lymphocyte ratio (NLR) with esophagojejunostomy leakage that subsequently required invasive treatment.
A retrospective study included patients that underwent esophagojejunostomy within the time frame of 2002-2017. Patients were grouped into those with or without anastomotic leakage that had conservative treatment (group A) and those with anastomotic leakage that had invasive treatment (group B). ROC curves and the Youden index were used for the optimum cutoff values of the NLR.
Fifty-seven patients were included. Thirty-two (56.14%) were men, and mean patient age was 61.8 ± 13.4 years. Forty-five patients were assigned to group A and 12 to group B. Mean NLR was higher for group B on postoperative day 3 (group A 9.5 ± 7.5 vs. group B 13.9 ± 4.9) (p = 0.05). Mean total leukocytes was higher in group B on postoperative day 5 (group A 7.8 ± 3.4 × 10/mcl vs. group B 10.3 ± 4.4 × 10/mcl) (p = 0.03). NLR and total leukocyte accuracy on postoperative day 3 was calculated with ROC curves, at 0.78 and 0.63, respectively. For the NLR and leukocyte count, sensitivity was 91.7% and 58%, specificity was 64.4% and 60%, positive predictive value was 40% and 28%, and negative predictive value was 96% and 84%, respectively.
Postoperatively, the NLR identified the total gastrectomy with esophagojejunostomy patients that subsequently required an invasive procedure secondary to esophagojejunostomy leakage.
全胃切除术用于多种病理情况。食管空肠吻合口漏是一种常见的并发症。我们的目的是确定中性粒细胞与淋巴细胞比值（NLR）与需要侵入性治疗的食管空肠吻合口漏之间的关联。
一项回顾性研究纳入了 2002 年至 2017 年期间行食管空肠吻合术的患者。患者分为吻合口漏且接受保守治疗的患者（A 组）和吻合口漏且接受侵入性治疗的患者（B 组）。使用 ROC 曲线和 Youden 指数确定 NLR 的最佳截断值。
共纳入 57 例患者，其中 32 例（56.14%）为男性，平均年龄为 61.8±13.4 岁。45 例患者被分配到 A 组，12 例患者被分配到 B 组。B 组患者术后第 3 天 NLR 较高（A 组 9.5±7.5 比 B 组 13.9±4.9）（p=0.05）。B 组患者术后第 5 天白细胞总数较高（A 组 7.8±3.4×10/mcl 比 B 组 10.3±4.4×10/mcl）（p=0.03）。通过 ROC 曲线计算术后第 3 天 NLR 和白细胞计数的准确性，分别为 0.78 和 0.63。对于 NLR 和白细胞计数，灵敏度分别为 91.7%和 58%，特异性分别为 64.4%和 60%，阳性预测值分别为 40%和 28%，阴性预测值分别为 96%和 84%。
术后，NLR 可识别出需要进行侵入性治疗的全胃切除术后伴食管空肠吻合口漏的患者。
