Lee Jong Min, Lee Jeehye, Kim Taehyung, Kim Nam Kyu
Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
Yonsei Med J. 2025 Aug;66(8):482-490. doi: 10.3349/ymj.2024.0431.
A high index of suspicion is crucial for early anastomotic leak (AL) diagnosis, enabling timely intervention and conservative management. Although recent studies have highlighted the potential of drain amylase (dAmy) as a predictive marker for AL, its application in colorectal surgery remains underexplored.
A retrospective study was conducted among patients who underwent colorectal resection between March 2020 and November 2023. A total of 299 patients with at least one dAmy and serum amylase (sAmy) measurement between postoperative days 1 to 5 were included, after excluding patients with fecal diversion.
Multiple logistic regression identified the drain/serum amylase ratio (d/s Amy) as an independent predictor of AL (odds ratio 1.032, 95% confidence interval 1.009-1.056; =0.007). The receiver operating characteristic curve demonstrated significant diagnostic ability for AL [area under the curve (AUC)=0.691], with a cut-off value of 2.54, a sensitivity of 48.4%, and a specificity of 94.2%. Patients with d/s Amy ≥2.54 had a significantly higher incidence of AL with a faster diagnosis compared to conventional methods (3.5 days vs. 5 days, =0.006). In patients who underwent ileal anastomosis, the d/s Amy ratio had an AUC of 0.936, with a sensitivity of 87.5% and a specificity of 96.6%.
The postoperative d/s Amy ratio is valuable for early AL detection in patients undergoing colorectal surgery, particularly in those with ileal anastomosis. This simple and noninvasive test can aid in timely diagnosis, offering earlier intervention compared with conventional methods.
高度怀疑指数对于早期吻合口漏（AL）的诊断至关重要，有助于及时干预和保守治疗。尽管最近的研究强调了引流液淀粉酶（dAmy）作为AL预测标志物的潜力，但其在结直肠手术中的应用仍未得到充分探索。
对2020年3月至2023年11月期间接受结直肠切除术的患者进行回顾性研究。排除粪便转流患者后，共纳入299例在术后第1至5天至少进行过一次dAmy和血清淀粉酶（sAmy）测量的患者。
多因素逻辑回归分析确定引流液/血清淀粉酶比值（d/s Amy）是AL的独立预测因素（比值比1.032，95%置信区间1.009 - 1.056；P = 0.007）。受试者工作特征曲线显示其对AL具有显著的诊断能力[曲线下面积（AUC）= 0.691]，截断值为2.54，灵敏度为48.4%，特异度为94.2%。与传统方法相比，d/s Amy≥2.54的患者AL发生率显著更高，诊断时间更快（3.5天对5天，P = 0.006）。在接受回肠吻合术的患者中，d/s Amy比值的AUC为0.936，灵敏度为87.5%，特异度为96.6%。
术后d/s Amy比值对于结直肠手术患者早期AL的检测具有重要价值，尤其是在回肠吻合术患者中。这种简单且无创的检测方法有助于及时诊断，与传统方法相比能提供更早的干预。
