粘连性肠梗阻手术干预的危险因素分析
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摘要
目的分析粘连性肠梗阻患者手术相关的危险因素,建立模型预测患者手术风险并评估该模型的有效性。方法回顾性分析2014～2017年湖南省人民医院普外科诊断为粘连性肠梗阻患者的临床资料,将患者按不同诊断时间分为预测组和验证组,比较预测组中保守治疗与手术治疗患者的临床资料差异,筛选出有统计学意义指标进行一般Logistic回归分析,根据b值建立预测模型,模型用于验证组患者,计算敏感性、特异性以评价模型有效性。结果保守组和手术组患者平均年龄、腹水比较,差异有统计学意义(P<0.05)。Logistic回归分析提示年龄≥65岁和存在腹水为是否手术的影响因素(P<0.05)。高危组患者的特异性为96%,低危组患者的敏感性为100%。结论该风险预测模型能对保守治疗粘连性肠梗阻患者进行手术风险分层,为是否进一步手术干预提供指导。
Objective To analyze the risk factors associated with surgery in patients with adhesive intestinal obstruction, and to establish a risk prediction model and evaluate its effectiveness. Methods The clinical data of the patient diagnosed as adhesive small bowel obstruction in General Surgery Department of Hunan Provincial People's Hospital from January 1, 2014 to December 31, 2015(derivation cohort) and from January 1, 2016 to December31, 2017(validation cohort) were retrospectively analyzed. The clinical data of the patients were compared between the non-surgical and surgical groups in derivation cohort. The statistically significant indicators were selected for Logistic regression analysis and the predictive model was established according to the b-factor. The model was used in validation cohort, and the sensitivity and specificity were calculated. Results Univariate analysis indicated that age(P < 0.05) and ascites(P < 0.05) were statistically different between the surgical and non-surgical groups.Logistic regression analysis indicated that the age of ≥ 65(b =1.6, P < 0.05) and the presence of ascites(b =1.7,P < 0.05) were important indicators. The specificity of the high-risk group was 96% and the sensitivity of the low-risk group was 100%. Conclusions The prediction model performs well for risk stratification of surgical intervention or conservative strategy among ASBO patients.
Objective To analyze the risk factors associated with surgery in patients with adhesive intestinal obstruction, and to establish a risk prediction model and evaluate its effectiveness. Methods The clinical data of the patient diagnosed as adhesive small bowel obstruction in General Surgery Department of Hunan Provincial People's Hospital from January 1, 2014 to December 31, 2015(derivation cohort) and from January 1, 2016 to December31, 2017(validation cohort) were retrospectively analyzed. The clinical data of the patients were compared between the non-surgical and surgical groups in derivation cohort. The statistically significant indicators were selected for Logistic regression analysis and the predictive model was established according to the b-factor. The model was used in validation cohort, and the sensitivity and specificity were calculated. Results Univariate analysis indicated that age(P < 0.05) and ascites(P < 0.05) were statistically different between the surgical and non-surgical groups.Logistic regression analysis indicated that the age of ≥ 65(b =1.6, P < 0.05) and the presence of ascites(b =1.7,P < 0.05) were important indicators. The specificity of the high-risk group was 96% and the sensitivity of the low-risk group was 100%. Conclusions The prediction model performs well for risk stratification of surgical intervention or conservative strategy among ASBO patients.
引文
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[7]张壮儒,林楚怀,杨永怀.血清肌酸激酶,C-反应蛋白和D-二聚体水平的测定在绞窄性肠梗阻早期诊断中的应用价值[J].中医临床研究,2016,8(21):13-14.
[8]BALTHAZAR E J.Clinical imaging of the small intestine[M].New York:Springer Science Business Media,2001:3.
[9]MILLET I,TAOUREL P,RUYER A,Value of CT findings to predict surgical ischemia in small bowel obstruction:a systematic review and meta-analysis[J].European Radiology,2015,25(6):1823-1835.
[10]胡孝海,田进.绞窄性肠梗阻患者诊断指标的多因素分析[J].胃肠病学和肝病学杂志,2015,24(3):298-300.
[11]OZTURK E,VAN I M,STOMMEL M M,et al.Small bowel obstruction in the elderly:a plea for comprehensive acute geriatric care[J].World Journal of Emergency Surgery,2018,13(1):48.
[12]K?STENBAUER J,TRUSKETT P G.Current management of adhesive small bowel obstruction[J].ANZ Journal of Surgery,2018,88(11):1117-1122.
[2]SAZHIN A,TYAGUNOV A,LARICHEV S,et al.Optimal time of surgery for acute adhesive small bowel obstruction[J].Khirurgiia,2018(3):24-30.
[3]TEIXEIRA P G,KARAMANOS E,TALVING P,et al.Early operation is associated with a survival benefit for patients with adhesive bowel obstruction[J].Annals of Surgery,2013,258(3):459-465.
[4]HUANG X,FANG G,LIN J,et al.A prediction model for recognizing strangulated small bowel obstruction[J].Gastroenterology Research and Practice,2018:DOI:10.1155/2018/7164648.
[5]QUEZADA-SANHUEZA N,LEóN-FERRUFINO F,B?CHLER-GONZáLEZ J,et al.The role of contrast-enhanced computed tomography scan in clinical decision in the management of adhesive small bowel obstruction[J].Cirugia y Cirujanos,2014,82(6):637-646.
[6]唐阳,彭琼.肠梗阻手术干预的多因素分析及保守治疗患者随访研究[J].河北医药,2017,39(18):2743-2746.
[7]张壮儒,林楚怀,杨永怀.血清肌酸激酶,C-反应蛋白和D-二聚体水平的测定在绞窄性肠梗阻早期诊断中的应用价值[J].中医临床研究,2016,8(21):13-14.
[8]BALTHAZAR E J.Clinical imaging of the small intestine[M].New York:Springer Science Business Media,2001:3.
[9]MILLET I,TAOUREL P,RUYER A,Value of CT findings to predict surgical ischemia in small bowel obstruction:a systematic review and meta-analysis[J].European Radiology,2015,25(6):1823-1835.
[10]胡孝海,田进.绞窄性肠梗阻患者诊断指标的多因素分析[J].胃肠病学和肝病学杂志,2015,24(3):298-300.
[11]OZTURK E,VAN I M,STOMMEL M M,et al.Small bowel obstruction in the elderly:a plea for comprehensive acute geriatric care[J].World Journal of Emergency Surgery,2018,13(1):48.
[12]K?STENBAUER J,TRUSKETT P G.Current management of adhesive small bowel obstruction[J].ANZ Journal of Surgery,2018,88(11):1117-1122.