Examination the role of C reactive protein as an early predictor of the wound line dehiscence in various types of reconstruction in elective abdominal surgery

[M. Šćepanović]

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Medicina - Rekonstruktivna hirurgija / Medicine - Reconstructive Surgery

abdominalnoj hirurgiji, najvažniji i najčešći operativni zahvat predstavlja resekcija obolelog segmenta sa istovremenom anastomozom presečenih krajeva u svrhu uspostavljanja intestinalnog kontinuiteta. Najvažnije za uspeh operativnog lečenja je uspešno zarastanje intestinalne anastomoze. U pokušaju ranog otkrivanja njenog neuspešnog zarastanja ispitivani su različiti biomarkeri među kojima i C reaktivni protein (CRP). CILJ: Ispitivanje uloge CRP-a u predikciji problematičnog zarastanja šavne linije na digestivnim anastomozama u prvoj nedelji posle operacije. METOD: Istraživanje je obuhvatilo 100 pacijenata obolelih od benigne i maligne bolesti digestivnog trakta, koji su hirurški lečeni na Klinici za hirurgiju Kliničko Bolničkog Centra Zvezdara, u Beogradu, u periodu od 2014. do 2015.godine. U postoperativnom toku merene su vrednosti CRP-a, leukocita i telesne temperature i njihove vrednosti praćenje u odnosu na razvoj svih postoperativnih komplikacija. REZULTATI: Pacijenti sa komplikacijama u postoperativnom toku imali su više vrednosti leukocita svakoga dana počevši od trećeg postoperativnog dana u odnosu na pacijente koji nisu imali komplikacije, iako njihova vrednost nije značajno prelazila referentne vrednosti. Beležeći postoperativnu visinu telesne temperature, značajno više prosečne vrednosti imali su pacijenti sa dehiscencijom anastomoze III, V i VI postoperativnog dana u odnosu na pacijente koji nisu imali komplikacije iako srednja vrednost nije nije značajno prelazila 37C. Vrednosti CRP-a II PO dana skoro 9 puta su veće od preoperativnih kod pacijenata koji nemaju postoperativne komplikacije, a 14 puta veće kod pacijenata koji su ih imali. ZAKLJUČAK: Određivanje postoperativnih vrednosti CRP-a može da ukaže na problematično zarastanje anastomoze na digestivnom traktu pre pojave kliničkih znakova.

In abdominal surgery, the most important and most common surgical procedure is the resection of the diseased segment with simultaneous anastomosis of the cut ends for the purpose of establishing intestinal continuity. The most important for the success of operative treatment is successful healing of intestinal anastomosis. In the attempt of early detection of its unsuccessful healing, various biomarkers were studied, among them C reactive protein (CRP). OBJECTIVE: Testing the role of CRP in the prediction of problematic healing of the wound line on digestive anastomosis in the first week after surgery. METHOD: The study included 100 patients with benign and malignant digestive tract diseases, who were surgically treated at the Clinic for Surgery at the Clinical Hospital Center Zvezdara in Belgrade in the period from 2014. to 2015. In the postoperative course, the values of CRP, leukocyte and body temperature and their values were measured in relation to the development of all postoperative complications. RESULTS: Patients with complications in the postoperative course had more leukocyte values every day starting from the third postoperative day compared to patients who did not have complications, although their value did not significantly exceed the reference values. By recording the postoperative height of body temperature, significantly more average values had patients with dehiscence of anastomosis III, V, and VI postoperative days compared to patients who did not have complications, although the mean did not significantly exceed 37C. The values of CRP on the second postoperative day are almost 9 times greater than preoperative in patients who have no postoperative complications and 14 times greater in patients who had them. CONCLUSION: Determination of postoperative values of CRP can indicate a problematic healing of digestive tract anastomosis before the appearance of clinical signs.

abdominalna hirurgija, dehiscencija, anastomoza, C rektivni protein

abdominal surgery, dehiscence, anastomosis, C reactive protein

616.3-089(043.3)

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