中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报

• 论著 • 上一篇    

老年绞窄性小肠梗阻手术相关因素分析

田晶1,2, 管文贤1, 何健3, 周竹萍3, 冯敏1, 汪灏1, 王军2   

  1. 1南京医科大学鼓楼临床医学院医院普外科,南京 210008;
    南京大学医学院附属鼓楼医院2急诊中心3放射科,南京 210008
  • 收稿日期:2017-07-18 出版日期:2018-05-03 发布日期:2018-05-03
  • 通讯作者: 管文贤 电话:025-68182098,传真:025-68182097,电子邮件:guan-wx@163.com
  • 基金资助:
    国家重点研发计划(2016YFC0104105)

Analysis of Related Factors in Elderly Patients with Strangulated Small Bowel Obstruction

TIAN Jing1,2, GUAN Wenxian1, HE Jian3, ZHOU Zhuping 3 , FENG Min1, WANG Hao1, WANG Jun2   

  1. 1Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China;
    2Department of Emergency, 3Department of Radiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2017-07-18 Online:2018-05-03 Published:2018-05-03
  • Contact: GUAN Wenxian Tel:025-68182098, Fax:025-68182097,E-mail:guan-wx@163.com
  • Supported by:
    Supported by the National Key R&D Program of China(2016YFC0104105)

摘要: 目的 分析老年绞窄性小肠梗阻的手术相关因素。方法 回顾性分析2010年6月至2016年9月在南京医科大学鼓楼临床医学院医院普外科住院治疗的261例老年急性小肠梗阻患者的临床资料,分为老年绞窄组(ESt组,n=139)和老年单纯组(ESi组,n=122)两组,对两组患者的临床症状、体征、放射学及实验室检测指标进行比较。采用单因素和多因素Logistic回归分析法分析老年绞窄性小肠梗阻的手术相关因素。结果 两组患者在肌卫(χ2=102.331,P=0.000)、ASA评分≥3(χ2=69.748,P=0.000)、白细胞增高(t=7.453,P=0.000)、C反应蛋白(t =2.128,P=0.034)、CT提示肠系膜积液(χ2=78.655,P=0.000)、肠壁增厚(χ2=100.806,P=0.000)、肠壁密度增高(χ2=69.068,P=0.000)、腹水(χ2=89.299,P=0.000)、肠系膜脂肪密度增高(χ2=80.255,P=0.000)、鸟嘴征(χ2=84.451,P=0.000)和缆绳征(χ2=98.635,P=0.000)方面差异有统计学意义。单因素Logistic回归分析结果显示,上述11个因素均为老年绞窄性小肠梗阻的手术相关因素。进一步多因素Logistic回归结果显示,CT提示肠系膜积液(OR=3.576,95%CI: 1.043~12.261,P=0.043)、ASA评分≥3(OR =3.463,95%CI: 1.149~10.441,P=0.027)、肌卫(OR =3.288,95%CI: 1.010~10.707,P=0.048)、CT提示肠壁增厚(OR =3.046,95%CI: 1.074~8.638,P=0.036)和WBC增高(OR =1.307,95%CI: 1.170~1.458,P=0.000)是老年绞窄性小肠梗阻的手术相关因素。结论 肌卫、ASA评分≥3、白细胞计数增高、CT提示肠系膜积液和肠壁增厚是老年绞窄性小肠梗阻的手术相关因素。

关键词: 急性小肠梗阻, 绞窄性小肠梗阻, 相关因素, 老年

Abstract: Objective To investigate the surgery-related factors of strangulated small bowel obstruction in the elderly patients. Methods The clinical data of 261 elderly patients with acute small bowel obstruction treated between July 2010 and September 2016 were analyzed retrospectively. Differences of clinical data, laboratory results, and CT findings were compared between the elderly strangulation group(ESt group,n=139)and the elderly simple group (ESi group,n=122). The surgery-related factors of strangulated small bowel obstruction in the elderly were analyzed by univariate and multivariate Logistic regression analysis. Results The ESt group and the ESi group showed significant differences in factors including muscle guarding (χ2=102.331,P=0.000), ASA score≥3 (χ2=69.748, P=0.000), leukocyte count (t=7.453, P=0.000), C-reactive protein (t =2.128, P=0.034), segmental mesenteric fluid (χ2=78.655, P=0.000), thick-walled small bowel (χ2=100.806, P=0.000), intestinal wall of hyperattenuation (χ2=69.068, P=0.000), ascites (χ2=89.299, P=0.000), mesenteric fat stranding (χ2=80.255, P=0.000), bird’s beak sign (χ2=84.451, P=0.000), and stranding sign (χ2=98.635, P=0.000). Univariate regression analysis indicated the above 11 factors were the surgery-related factors in elderly patients with strangulated small bowel obstruction. Multivariate Logistic regression analysis showed that the surgery-related factors included segmental mesenteric fluid (OR=3.576, 95%CI: 1.043 - 12.261, P=0.043), ASA score≥3 (OR =3.463, 95%CI: 1.149 - 10.441, P=0.027), muscle guarding (OR =3.288, 95%CI: 1.010 - 10.707, P=0.048), thick-walled small bowel (OR =3.046, 95%CI: 1.074 - 8.638,P=0.036), and increased leukocyte count (OR =1.307, 95%CI: 1.170 - 1.458, P=0.000). Conclusions Muscle guarding, ASA score≧3, segmental mesenteric fluid, thick-walled small bowel, and increased leukocyte count are the surgery-related factors of strangulated small bowel obstruction in the elderly patients.

Key words: acute small bowel obstruction, strangulated small bowel obstruction, surgery-related factors, the elderly

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