From the Departments of Radiology (I.M., A.R., C.A., F.C.D., E.P., P.T.) and Biostatistics (N.M.), Hôpital Lapeyronie, CHU Montpellier, 371 Avenue du Doyen Gaston Giraud, Montpellier 34295, France; Department of Radiology, Fondation Hôpital Saint Joseph, Paris, France (M.Z.); and CIC Inserm 2001, University of Montpellier I, Montpellier, France (I.M., P.T.).
Radiology. 2014 Nov;273(2):425-32. doi: 10.1148/radiol.14132872. Epub 2014 Jul 4.
To identify computed tomographic (CT) findings that are associated with the effectiveness of nonsurgical treatment in patients with adhesive small-bowel obstruction ( SBO small-bowel obstruction ) that was initially treated medically.
The local institutional review board approved this retrospective study; the informed consent requirement was waived. Multi-detector row CT studies in 159 patients (64 women, 95 men; median age, 69 years) with adhesive SBO small-bowel obstruction that was initially treated medically were reviewed retrospectively and independently by two emergency radiologists to identify numerous CT findings that could be associated with the effectiveness of nonsurgical treatment. Results were compared according to the success or failure of nonsurgical treatment. Univariate statistical analyses were performed for qualitative and quantitative data, as appropriate, and each significant parameter was entered in a multivariate logistic regression analysis. The κ statistic and correlation coefficients were used to assess interobserver agreement, as appropriate.
Nonsurgical treatment succeeded in 113 patients (71%) and failed in 46 patients (29%). At univariate analysis, an anterior parietal adhesion, a feces sign, and the lack of a beak sign were associated with successful nonsurgical treatment, whereas two beak signs or more, a whirl sign, a C- or U-shaped appearance of the bowel loop, and a high degree of obstruction were associated with nonsurgical treatment failure. At multivariate analysis, fewer than two beak signs and the presence of an anterior parietal adhesion were independent predictors of the effectiveness of nonsurgical treatment, with odds ratios of 0.27 and 0.11, respectively.
The number of beak signs and the location of the transition zone in relation to the anterior peritoneal layer are independent signs associated with the success or failure of nonsurgical treatment.
确定与最初接受内科治疗的粘连性小肠梗阻（SBO 小肠梗阻）患者非手术治疗效果相关的计算机断层扫描（CT）表现。
本回顾性研究经当地机构审查委员会批准，豁免了知情同意书要求。回顾性分析了 159 例（64 例女性，95 例男性；中位年龄 69 岁）最初接受内科治疗的粘连性 SBO 小肠梗阻患者的多排 CT 研究，由两位急诊放射科医生独立回顾并识别可能与非手术治疗效果相关的多种 CT 表现。根据非手术治疗的成功或失败来比较结果。适当的情况下，对定性和定量数据进行单变量统计分析，将每个有意义的参数输入多变量逻辑回归分析。适当情况下使用κ统计量和相关系数评估观察者间的一致性。
113 例（71%）患者的非手术治疗成功，46 例（29%）患者的非手术治疗失败。单变量分析显示，前壁粘连、粪便征和无喙征与非手术治疗成功相关，而两个或更多喙征、漩涡征、肠袢 C 形或 U 形外观和高度梗阻与非手术治疗失败相关。多变量分析显示，喙征少于两个和存在前壁粘连是非手术治疗效果的独立预测因素，优势比分别为 0.27 和 0.11。
喙征数量和与前腹膜层相关的过渡区位置是与非手术治疗成功或失败相关的独立征象。
