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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (02) : 152 -157. doi: 10.3877/cma.j.issn.2095-3224.2023.02.010

综述

直肠癌术后吻合口漏影响因素及其预测性生物标志物的研究进展
张成仁1, 吕耀春2, 杨熊飞1,†(), 杜斌斌1,†()   
  1. 1. 750000　银川，宁夏医科大学临床医学院；730000　兰州，甘肃省人民医院肛肠科；730000　兰州，甘肃省肛肠疾病临床医学研究中心
    2. 730000　兰州，甘肃省人民医院肛肠科；730000　兰州，甘肃省肛肠疾病临床医学研究中心
  • 收稿日期:2022-02-20 出版日期:2023-04-25
  • 通信作者: 杨熊飞, 杜斌斌
  • 基金资助:
    甘肃省科学技术厅重点研发计划(22YF7FA097); 兰州市科学技术局科技发展计划项目(2022-5-51); 甘肃省肛肠疾病临床医学研究中心(20JR10RA434); 甘肃省人民医院院内科研基金(20GSSY3-1，21GSSYC-20); 兰州市科学技术局基金(2022-ZD-47)

Research progress on influencing factors and diagnostic biomarkers of anastomotic leakage in postoperative rectal cancer

Chengren Zhang1, Yaochun Lv2, Xiongfei Yang1,†(), Binbin Du1,†()   

  1. 1. Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou 730000, China
  • Received:2022-02-20 Published:2023-04-25
  • Corresponding author: Xiongfei Yang, Binbin Du
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张成仁, 吕耀春, 杨熊飞, 杜斌斌. 直肠癌术后吻合口漏影响因素及其预测性生物标志物的研究进展[J]. 中华结直肠疾病电子杂志, 2023, 12(02): 152-157.

Chengren Zhang, Yaochun Lv, Xiongfei Yang, Binbin Du. Research progress on influencing factors and diagnostic biomarkers of anastomotic leakage in postoperative rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(02): 152-157.

近年来，随着医疗技术的不断发展加之精密吻合仪器的不断成熟，使得部分患者的保肛意愿得以实现，但同时也增加了吻合口漏的发生率。直肠癌术后吻合口漏是危及患者生命的并发症，发生率在2.4%~15.9%之间，死亡率约为16%，主要的危险因素包括吸烟、饮酒、肥胖、糖尿病以及营养不良等。吻合口漏不仅影响患者的生存预后，还给患者带来极大的心理负担。因此，探寻直肠癌术后吻合口漏的危险因素以及预防吻合口漏的发生成为临床医生关注的重点。笔者就直肠癌术后吻合口漏的影响因素及其预测性生物标志物进行文献综述，以期为临床医生提供帮助。

关键词: 直肠肿瘤, 吻合口漏, 影响因素, 生物标志物

In recent years, with the continuous development of medical technology and the continuous maturity of precision anastomosis instruments, the willingness of some patients to preserve anus has been realized, but at the same time, it has also increased the incidence of anastomotic leakage. Postoperative anastomotic leakage of rectal cancer is a life-threatening complication with an incidence of 2.4% to 15.9% and a mortality rate of about 16%. The main risk factors include smoking, alcohol consumption, obesity, diabetes and malnutrition. Anastomotic leakage not only affects the prognosis of patients, but also brings great psychological burden to patients. Therefore, to explore the risk factors of anastomotic leakage after rectal cancer surgery and to prevent the occurrence of anastomotic leakage has become the focus of clinicians. This article reviews the Influencing factors and predictive biomarkers of postoperative anastomotic leakage in rectal cancer, in order to provide help for clinicians.

Key words: Rectal neoplasms, Anastomotic leakage, Influencing factors, Biomarkers
表1 直肠癌术后吻合口漏相关影响因素
患者自身因素 手术相关因素
ASA评分 吸烟、酗酒贫血 术前使用抗生素 术中出血、输血
营养不良 糖尿病 术前使用激素 手术方式
肠道菌群 BMI 术前放化疗 手术时间
年龄、性别 肿瘤大小 术前肠道准备 预防性引流
组织氧合 肿瘤分期 吻合口距肛缘的距离 保护性造口
表2 吻合口漏的预测性生物标志物
炎症性生物标志物 缺血性生物标志物及其他
C反应蛋白 白细胞 pH
降钙素原 中性粒细胞 乳酸/丙酮酸比率
白蛋白 中性粒细胞/淋巴细胞比值 预测模型或评分
低钠血症 白血病抑制因子 肠脂肪酸结合蛋白
白细胞介素 单核细胞趋化蛋白2 溶菌酶
肿瘤坏死因子 上皮中性粒细胞激活肽-78 新蝶呤
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