引流液中的内毒素作为结直肠手术后吻合口漏的早期预测指标。
Endotoxin in drainage fluid as an early and predictive marker of anastomotic leakage after colorectal surgery.
作者信息
Matsunaga Takashi, Miyake Toru, Maekawa Takeru, Tsukaguchi Fumie, Obata Toru, Shimizu Tomoharu, Tani Masaji
机构信息
Department of Surgery, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
Medical Safety Section, Shiga University of Medical Science Hospital, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
出版信息
Surg Today. 2025 Jul 23. doi: 10.1007/s00595-025-03106-x.
PURPOSE
To assess the predictive value of the endotoxin (ET) assay for the detection of anastomotic leakage (AL) after colorectal surgery (CRS).
METHODS
ET levels in the drainage fluid were measured using endotoxin scattering photometry (ET-ESP) and turbidimetric (ET-TUB) assays on postoperative day (POD) zero, POD1 and POD3, comparing tumor necrosis factor (TNF)-α.
RESULTS
AL was observed in 8 (4.9%) of the 162 patients. ET-ESP, ET-TUB, and TNF-α levels on POD0 and serum C-reactive protein (CRP) on POD1 were significantly elevated in the AL group. The area under the receiver operating characteristic curve (AUROC) for ET-ESP level (0.903) on POD0 showed early and better predictive performance for AL compared to that for ET-TUB (0.869, p = 0.230) and TNF-α (0.758, p = 0.034) levels on POD0; the AUROC for CRP level (0.711) on POD1 was inferior to other parameters. In subgroup analysis, five (3.7%) of 136 patients with colorectal cancer (CRC) developed AL. Additionally, the ET-ESP level on POD0 showed relatively good predictive performance for AL after CRC (AUROC: ET-ESP [0.871], ET-TUB [0.840], and TNF-α [0.737] on POD0).
CONCLUSION
ET levels in drainage fluid, especially those measured using ESP, on POD0 may have an early predictive ability to detect AL post-CRS.
目的
评估内毒素（ET）检测对结直肠手术（CRS）后吻合口漏（AL）的预测价值。
方法
在术后第0天、第1天和第3天，采用内毒素散射比浊法（ET-ESP）和比浊法（ET-TUB）检测引流液中的ET水平，并与肿瘤坏死因子（TNF）-α进行比较。
结果
162例患者中有8例（4.9%）发生AL。AL组术后第0天的ET-ESP、ET-TUB和TNF-α水平以及术后第1天的血清C反应蛋白（CRP）水平显著升高。术后第0天ET-ESP水平的受试者工作特征曲线下面积（AUROC）为0.903，与术后第0天的ET-TUB（0.869，p = 0.230）和TNF-α（0.758，p = 0.034）水平相比，对AL具有早期且更好的预测性能；术后第1天CRP水平的AUROC为0.711，低于其他参数。在亚组分析中，136例结直肠癌（CRC）患者中有5例（3.7%）发生AL。此外，术后第0天的ET-ESP水平对CRC后AL具有相对较好的预测性能（术后第0天的AUROC：ET-ESP [0.871]，ET-TUB [0.840]，TNF-α [0.737]）。
结论
术后第0天引流液中的ET水平，尤其是采用ESP检测的ET水平，可能对CRS后AL具有早期预测能力。
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