临床因素和影像学特征对绞窄性肠梗阻不可逆肠缺血的预测价值  

Prognostic value of clinical factors and imaging features for irreversible intestinal ischemia in strangulated intestinal obstruction

作　　者：王永[1] 李丰[1] 赵林海[1] WANG Yong;LI Feng;ZHAO Lin-hai(Department of General Surgery,Zhoukou Central Hospital,Zhoukou,Henan 466000,China)

机构地区：[1]周口市中心医院普外科,河南周口466000

出　　处：《医药论坛杂志》2024年第7期772-775,780,共5页Journal of Medical Forum

摘　　要：目的分析临床因素和影像学特征对绞窄性肠梗阻不可逆肠缺血的预测价值。方法选取周口市中心医2021年1月至2023年11月收治的绞窄性肠梗阻患者83例,42例为不可逆性缺血坏死,需要肠切除;41例为可逆性肠缺血,不需要肠切除。收集患者入院时临床资料,确定不可逆肠缺血的独立预测因素,建立预测模型,评估预测模型的判别和校准。结果切除组患者碱剩余、白细胞(WBC)、中性粒细胞与淋巴细胞比值(NLR)、血尿素氮(BUN)、腹腔积液CT值,以及存在腹腔积液和肠壁强化差或无强化比率高于非切除组患者,NLR≥16.32和腹腔积液≥20.45HU是不可逆肠缺血的独立危险因素,每个项目分值2分,预测模型总分为0~4分。5倍交叉验证后预测模型的AUC分别为0.814和0.807,Hosmer-Lemeshow检验显示模型具有足够的拟合优度(P=0.391)。ROC曲线显示模型得分≥2分与不可逆肠缺血密切相关,需要进行肠切除术。结论包含NLR≥16.32和腹腔积液CT值≥20.45HU的模型有助于预测绞窄性肠梗阻的不可逆肠缺血,可使外科医生及时认识到病情的严重性,选择适当的手术方法进行治疗。Objective To analyze the value of clinical factors and imaging features in predicting irreversible intestinal ischemia in strangulated intestinal obstruction.Methods A total of 83 patients with strangulation ileus were selected from January 2021 to November 2023,42 of whom had irreversible ischemic necrosis and required intestinal resection.41 cases had reversible intestinal ischemia and no intestinal resection was required.Clinical data were collected at admission to identify independent predictors of irreversible intestinal ischemia,establish predictive models,and evaluate the discrimination and calibration of predictive models.Results Base residual,WBC,NLR,BUN,CT values of abdominal effusion,and the presence of abdominal effusion and the rate of poor or no enhancement of intestinal wall were higher in the excision group than of the non-excision group.NLR≥16.32 and abdominal effusion≥20.45HU were independent risk factors for irreversible intestinal ischemia,with a score of 2 for each item and a total score of 0~4 for the prediction model.The AUC of the prediction model after five-fold cross-validation was 0.814 and 0.807,respectively,and the Hosmer-Lemeshow test showed sufficient goodness of fit(P=0.391).ROC curve showed that model score≥2 was closely associated with irreversible intestinal ischemia,requiring intestinal resection.Conclusion A model containing NLR≥16.32 and CT value of abdominal fluid≥20.45HU can help predict irreversible intestinal ischemia in strangulated intestinal obstruction,enabling surgeons to timely recognize the severity of the condition and choose appropriate surgical methods for treatment.

关 键 词：绞窄性肠梗阻 计算机断层扫描 多维模型 术前诊断 

分 类 号：R574.2[医药卫生—消化系统]