Bestimmung von pH, pO2, TNF [alpha] und IL-6 in der peritonealen Drainageflüssigkeit zur Früherkennung einer postoperativen Anastomoseninsuffizienz

Peritonitis as a consequence of anastomotic leakage is in most cases larvated and an early diagnosis is difficult. To prevent this peritonitis it is necessary to detect the clinical complication of anastomotic leakage as early as possible. Over the past few years several studies have been conducted to show the peritoneal fluid changes, which indicate an intra-abdominal infection as a result of an anastomotic leakage. Therefore, several parameters in the peritoneal fluid were analysed, but with very conflicting results. Against this background, a prospective study on 69 patients, who underwent a visceral surgical procedure in the Departement of Surgery, Rhenish- Westphelian Technical University, Aachen, Germany (Prof. Dr. med. Dr .h. c. V. Schumpelick) was conducted. The evaluation of special parameters (pH, pO2, interleukin [IL] -6 and tumor necrosis factor [TNF] Alpha) in postoperative peritoneal drainage fluid was studied over a seven day period, to prove whether these parameters were significant for early detection of an anastomotic leakage or not. In the investigated group all patients received either an intra-abdominal or a bilio-digestive anastomosis. Of this group 63 patients were free of complications defined as uneventful postoperative course without any signs of anastomotic leakage until the 14th postoperative day. 6 patients underwent relaparotomy because of anastomotic leakage. The measured pH, pO2, IL-6 and TNF Alpha data of these 6 patients could be compared with the measured data of the 63 patients who did not suffer from anastomotic leakage, in order to find the differences for the early detection of an anastomotic leakage. The use of a combined threshold for pH (pH < 7,1) and pO2 (pO2 < 49 mmHg) makes a significant distinction between patients with and without an anastomotic leakage from the fifth postoperative day on, with a sensitivity of 50%, a specificity of 100% and a positive diagnostic value of 100%. After elective intra-abdominal surgery, the monitoring of postoperative drainage fluid pH and pO2 is helpful for the early detection of an anastomotic leakage. In contrast, neither the evaluation of IL-6 or TNF Alpha in the postoperative drainage fluid had any prognostic value for an early detection or revision in patients with anastomotic leakage. It was not possible to detect a threshold in the peritoneal drainage fluid through the daily measurement of IL-6 and TNF Alpha in neither the group of 69 patients, nor in a selection group of 25 Patients following a colorectal surgical procedure. A significant distinction could not be shown for IL-6 and TNF Alpha.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2005

Author dc:creator

• Meiser, Corinna

Contributors dc:contributor

• Schumpelick, Volker

• info:eu-repo/classification/ddc/610
• Medizin
• Marker
• Anastomoseninsuffizienz

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-208195%22

OAI identifier oai:identifier

oai:publications.rwth-aachen.de:62090