Department of Surgery, Yoshinogawa Medical Center, 120 Nishichiejima, Yoshinogawa City, Tokushima, 776-8511, Japan.
World J Emerg Surg. 2021 Mar 30;16(1):17. doi: 10.1186/s13017-021-00359-y.
"Dirty mass" is a specific computed tomography (CT) finding that is seen frequently in colorectal perforation. The prognostic significance of this finding for mortality is unclear.
Fifty-eight consecutive patients with colorectal perforation who underwent emergency surgery were retrospectively reviewed in the study. Dirty mass identified on multi-detector row CT (MDCT) was 3D-reconstructed and its volume was calculated using Ziostation software. Dirty mass volume and other clinical characteristics were compared between survivor (n = 45) and mortality groups (n = 13) to identify predictive factors for mortality. Mann-Whitney U test and Χ test were used in univariate analysis and logistic regression analysis was used in multivariate analysis.
Dirty mass was identified in 36/58 patients (62.1%) and located next to perforated colorectum in all cases. Receiver-operating characteristic (ROC) curve analysis identified the highest peak at 96.3 cm, with sensitivity of 0.643 and specificity of 0.864. Univariate analysis revealed dirty mass volume, acute disseminated intravascular coagulation (DIC) score, acute physiology and chronic health evaluation II (APACHE II) score, and sequential organ failure assessment (SOFA) score as prognostic markers for mortality (p<0.01). Multivariate analysis revealed dirty mass volume and APACHE II score as independent prognostic indicators for mortality. Mortality was stratified by dividing patients into four groups according to dirty mass volume and APACHE II score.
The combination of dirty mass volume and APACHE II score could stratify the postoperative mortality risk in patients with colorectal perforation. According to the risk stratification, surgeons might be able to decide the surgical procedures and intensity of postoperative management.
“污物肿块”是一种在结直肠穿孔中经常见到的特定 CT 表现。目前尚不清楚该表现对死亡率的预后意义。
本研究回顾性分析了 58 例接受急诊手术的结直肠穿孔患者。多排螺旋 CT（MDCT）上的污物肿块采用 3D 重建，并用 Ziostation 软件计算其体积。比较存活组（n=45）和死亡组（n=13）的污物肿块体积和其他临床特征，以确定死亡的预测因素。采用 Mann-Whitney U 检验和 Χ 检验进行单因素分析，采用逻辑回归分析进行多因素分析。
36/58 例（62.1%）患者 MDCT 上可见污物肿块，且均位于穿孔的结直肠旁。受试者工作特征（ROC）曲线分析显示，最高峰值为 96.3cm，灵敏度为 0.643，特异度为 0.864。单因素分析显示，污物肿块体积、急性弥散性血管内凝血（DIC）评分、急性生理学和慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分和序贯器官衰竭评估（SOFA）评分是死亡率的预后标志物（p<0.01）。多因素分析显示，污物肿块体积和 APACHE Ⅱ评分是死亡率的独立预后指标。根据污物肿块体积和 APACHE Ⅱ评分将患者分为四组，分层死亡率。
污物肿块体积和 APACHE Ⅱ评分的组合可分层结直肠穿孔患者的术后死亡风险。根据风险分层，外科医生可能能够决定手术程序和术后管理的强度。
