Gonzalez L M, Fogle C A, Baker W T, Hughes F E, Law J M, Motsinger-Reif A A, Blikslager A T
College of Veterinary Medicine, North Carolina State University, Raleigh, USA.
Equine Vet J. 2015 May;47(3):279-84. doi: 10.1111/evj.12273. Epub 2014 May 29.
There is an important need for objective parameters that accurately predict the outcome of horses with large colon volvulus.
To evaluate the predictive value of a series of histomorphometric parameters on short-term outcome, as well as the impact of colonic resection on horses with large colon volvulus.
Retrospective cohort study.
Adult horses admitted to the Equine and Farm Animal Veterinary Center at North Carolina State University, Peterson and Smith and Chino Valley Equine Hospitals between 2006 and 2013 that underwent an exploratory coeliotomy, diagnosed with large colon volvulus of ≥360 degrees, where a pelvic flexure biopsy was obtained, and that recovered from general anaesthesia, were selected for inclusion in the study. Logistic regression was used to determine associations between signalment, histomorphometric measurements of interstitium-to-crypt ratio, degree of haemorrhage, percentage loss of luminal and glandular epithelium, as well as colonic resection with short-term outcome (discharge from the hospital).
Pelvic flexure biopsies from 47 horses with large colon volvulus were evaluated. Factors that were significantly associated with short-term outcome on univariate logistic regression were Thoroughbred breed (P = 0.04), interstitium-to-crypt ratio >1 (P = 0.02) and haemorrhage score ≥3 (P = 0.005). Resection (P = 0.92) was not found to be associated significantly with short-term outcome. No combined factors increased the likelihood of death in forward stepwise logistic regression modelling. A digitally quantified measurement of haemorrhage area strengthened the association of haemorrhage with nonsurvival in cases of large colon volvulus.
Histomorphometric measurements of interstitium-to-crypt ratio and degree of haemorrhage predict short-term outcome in cases of large colon volvulus. Resection was not associated with short-term outcome in horses selected for this study. Accurate quantification of mucosal haemorrhage at the time of surgery may improve veterinary surgeons' prognostic capabilities in horses with large colon volvulus.
迫切需要能够准确预测患有大结肠扭转的马匹预后的客观参数。
评估一系列组织形态计量学参数对短期预后的预测价值，以及结肠切除术对患有大结肠扭转的马匹的影响。
回顾性队列研究。
选取2006年至2013年间入住北卡罗来纳州立大学马与农场动物兽医中心、彼得森和史密斯以及奇诺谷马医院的成年马匹，这些马匹接受了剖腹探查术，被诊断为大结肠扭转≥360度，获取了骨盆弯曲部活检样本，且从全身麻醉中恢复过来，将其纳入研究。采用逻辑回归分析来确定信号因素、间质与隐窝比值的组织形态计量学测量值、出血程度、管腔和腺上皮损失百分比以及结肠切除术与短期预后（出院）之间的关联。
对47匹患有大结肠扭转的马匹的骨盆弯曲部活检样本进行了评估。在单变量逻辑回归分析中，与短期预后显著相关的因素有纯种马品种（P = 0.04）、间质与隐窝比值>1（P = 0.02）以及出血评分≥3（P = 0.005）。未发现切除术（P = 0.92）与短期预后有显著关联。在逐步向前逻辑回归模型中，没有联合因素增加死亡的可能性。大结肠扭转病例中，出血面积的数字量化测量加强了出血与非存活之间的关联。
间质与隐窝比值的组织形态计量学测量值和出血程度可预测大结肠扭转病例的短期预后。在本研究选取的马匹中，切除术与短期预后无关。手术时准确量化粘膜出血情况可能会提高兽医对患有大结肠扭转马匹的预后判断能力。
