成人急性大肠梗阻手术治疗预测因子的多因素分析  

Necessity of surgical treatment in adult patients with acute large bowel obstruction: a multivariate analysis of predictive factors

作　　者：李海风 战俊 李世宽[3] 李元博[3] 彭新刚[3] 

机构地区：[1]山东省青岛市胶州中心医院普通外科,山东青岛266300 [2]山东省青岛胶州人民医院神经外科,山东青岛266300 [3]青岛大学医学院附属医院急诊普通外科,山东青岛266042

出　　处：《中国现代普通外科进展》2016年第3期192-196,共5页Chinese Journal of Current Advances in General Surgery

摘　　要：目的 :探讨成人急性大肠梗阻手术治疗的预测因子,建立手术治疗的预测模型。方法 :回顾性分析2008年1月—2012年1月住院治疗的306例大肠梗阻的患者资料。结果:患者高热(体温>38.5℃)、非手术治疗时间、腹痛进行性加重、腹部压痛包块、腹膜炎体征、腹部手术史、白细胞计数、乳酸脱氢酶、尿素氮水平、CT检查见肠壁不规则增厚、结肠截断征、结肠内稀便、结肠内粪块等13个危险因素与大肠梗阻手术治疗密切相关。对有意义的13个变量行多因素Logistic回归分析,共有8个因素进入Logistic回归方程,按其作用的强度依次为:高热、肠壁不规则增厚、腹部压痛包块、腹膜炎体征、结肠内稀便、乳酸脱氢酶、白细胞计数和结肠内粪块。Logistic回归预测模型预测结肠梗阻是否手术治疗的准确度为88.56%(271/306),敏感度为94.58%(227/240),特异度为66.67%(44/66)。结论:8个因素Logistic回归模型可较好的预测成人急性大肠梗阻是否需要手术治疗。Objective： To explore the predictive factors of operative treatment for adult patients with acute large bowel obstruction and to establish a predictive model. Methods： Clinical data of 306 adult patients with acute large bowel obstruction treated during January 2008 and January 2012 were analyzed retrospectively. The clinical, laboratory and radiographic parameters of patients were evaluated as probable predictive factors for surgical treatment. Predictive factors associated with the surgical treatment were developed using logistic regression models. Results： 13 clinical variables, including high fever（T38.5 ℃）, duration of non-surgical treatment, progressive abdominal pain, abdominal mass, signs of peritonitis, history of abdominal operation, increased leukocyte count, lactate dehydrogenase and urea nitrogen, irregular bowel wall thickening, colonic cut-off sign, loose stools in colon, feces mass in colon, were analyze by a single factor analysis. By multivariate logistic regression analysis, there were 8 predictive factors for an operation in diminishing sequence as high fever,irregular bowel wall thickening, abdominal mass, signs of peritonitis, loose stools in colon, increased lactate dehydrogenase, leukocyte count and feces mass in colon. The accuracy, specificity and sensitivity of the logistic regression model were 88.56%, 94.58% and 66.67% respectively. Conclusion：The logistic regression model based on the 8 factors is reliable in predicting the necessity of operative treatment for patients with acute large bowel obstruction.

关 键 词：大肠梗阻 外科手术 预测因子 

分 类 号：R619[医药卫生—外科学]