Scrima Andrew, Lubner Meghan G, King Scott, Pankratz Joshua, Kennedy Gregory, Pickhardt Perry J
1 Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252.
AJR Am J Roentgenol. 2017 Apr;208(4):785-793. doi: 10.2214/AJR.16.16946.
The purpose of this article is to assess the value of a large panel of clinical and MDCT variables in patients with suspected small-bowel obstruction (SBO) for predicting urgent surgical intervention (< 72 hours), bowel ischemia, and bowel resection.
MDCT studies performed at admission for 179 nonconsecutive adults (mean age, 55.8 years; 86 men and 93 women) with suspected SBO were retrospectively reviewed by three board-certified radiologists. In addition to assessing individual CT features, each radiologist scored the overall likelihood of each main outcome measure using a 5-point scale. All relevant clinical and laboratory data were abstracted from electronic medical record review. Univariate and multivariate analyses were performed.
Among all 179 patients with suspected SBO, 56 (31.3%) underwent surgical intervention within 72 hours, 10 (5.6%) had ischemia at surgery, and nine (5.0%) required small-bowel resection. On univariate analysis, multiple CT findings were highly significant (p < 0.01) for predicting the main surgical outcomes, including degree of obstruction, 5-point radiology likelihood scores, and the presence of a transition point, closed loop, and mesenteric congestion. None of the objective clinical or laboratory variables (including serum lactate level) reached this level of significance. At multivariate analysis, forward stepwise logistic regression with 0.05 significance level cutoff included both degree of obstruction (p < 0.001) and closed loop (p < 0.01), with the presence of a transition point showing a trend toward significance (p = 0.081).
A number of findings at abdominal MDCT are associated with the need for surgery and other important surgical outcomes in patients with suspected SBO. Overall radiologist impression of need for surgical intervention was a better predictor than any clinical or laboratory parameter.
本文旨在评估大量临床和多层螺旋CT（MDCT）变量对疑似小肠梗阻（SBO）患者预测紧急手术干预（<72小时）、肠缺血和肠切除的价值。
对179例非连续性成年疑似SBO患者（平均年龄55.8岁；男性86例，女性93例）入院时进行的MDCT研究进行回顾性分析，由三名获得委员会认证的放射科医生进行。除了评估个体CT特征外，每位放射科医生使用5分制对每个主要结局指标的总体可能性进行评分。所有相关临床和实验室数据均从电子病历回顾中提取。进行单因素和多因素分析。
在所有179例疑似SBO患者中，56例（31.3%）在72小时内接受了手术干预，10例（5.6%）手术时出现缺血，9例（5.0%）需要小肠切除。单因素分析显示，多个CT表现对预测主要手术结局具有高度显著性（p<0.01），包括梗阻程度、5分制放射学可能性评分以及是否存在移行点、闭袢和肠系膜充血。客观临床或实验室变量（包括血清乳酸水平）均未达到这一显著水平。多因素分析中，显著性水平截断值为0.05的向前逐步逻辑回归包括梗阻程度（p<0.001）和闭袢（p<0.01），移行点的存在显示出显著趋势（p=0.081）。
腹部MDCT的一些表现与疑似SBO患者的手术需求和其他重要手术结局相关。放射科医生对手术干预需求的总体印象比任何临床或实验室参数都是更好的预测指标。
