Duan Sheng-jun, Liu Hua-shui, Niu Jun, Wang Chun-xiang, Chen Shou-hua, Wang Ming-hai
Department of General Surgery, Third People's Hospital of Jinan, Shandong University, Jinan, China (mainland).
Med Sci Monit. 2014 Feb 8;20:214-8. doi: 10.12659/MSM.889786.
There is currently no grading standard for the degree of clinical and bowel morphological changes. The objective of this study was to define clinical and bowel morphological classifications and investigate the possible relationship with the characteristics of patients with incarcerated groin hernias.
We retrospectively studied 195 patients who underwent emergency hernia repair with simultaneous bowel resection between January 1992 and January 2012. We classified the degree of clinical and bowel morphological changes into 3 grades based on the incarceration time, intestinal morphology after damage, hernia sac integrity, degree of inflammation, and the presence/absence of bacterial growth, peritonitis signs, mechanical obstruction, cellulitis, and systemic shock. We also recorded patient characteristics and analyzed their relationships with these degrees according to our grading system.
We identified 134, 42, and 19 cases of Grades I, II, and III of clinical and bowel morphological changes, respectively. Pearson's chi-squared tests revealed that advanced age (P=0.001), presence of comorbid disease (P=0.002), and high American Society of Anesthesiologists (ASA) score (P=0.017) were related to the degree. Morbidity and mortality also showed significant relationships with the degree (P<0.001, P=0.005, respectively), especially with regard to post-operative infection.
The proposed 3-stage classifications of clinical and bowel morphological changes can be used to objectively reflect the degree of bowel damage. Greater levels of the changes were associated with higher incidences of complications and increased mortality, especially for older patients with comorbid diseases and poor ASA scores. Urgent surgery should be performed to avoid bowel damage exacerbation.
目前尚无临床及肠道形态学改变程度的分级标准。本研究的目的是定义临床及肠道形态学分类，并探讨其与嵌顿性腹股沟疝患者特征之间的可能关系。
我们回顾性研究了1992年1月至2012年1月期间接受急诊疝修补术并同时进行肠切除的195例患者。我们根据嵌顿时间、损伤后肠道形态、疝囊完整性、炎症程度以及细菌生长情况、腹膜炎体征、机械性梗阻、蜂窝织炎和全身休克的有无，将临床及肠道形态学改变程度分为3级。我们还记录了患者特征，并根据我们的分级系统分析了它们与这些分级的关系。
我们分别确定了临床及肠道形态学改变I级、II级和III级的病例为134例、42例和19例。Pearson卡方检验显示，高龄（P = 0.001）、合并疾病的存在（P = 0.002）和美国麻醉医师协会（ASA）高评分（P = 0.017）与分级有关。发病率和死亡率也与分级显示出显著关系（分别为P < 0.001，P = 0.005），尤其是在术后感染方面。
所提出的临床及肠道形态学改变的3阶段分类可用于客观反映肠道损伤程度。改变程度越高，并发症发生率和死亡率越高，尤其是对于患有合并疾病且ASA评分差的老年患者。应进行紧急手术以避免肠道损伤加重。
