黏连性小肠梗阻：单束带还是广泛黏连？基于 CT 扫描的预测模型。
Adhesive small bowel obstruction: Single band or matted adhesions? A predictive model based on computed tomography scan.
机构信息
From the Humanitas Clinical and Research Center, IRCCS (J.G., D.P., S.M., M.C., H.K.), Rozzano, Milan; Department of Medical Sciences (D.Z.), University of Turin, Turin; Department of Biomedical Sciences (L.S., G.C., L.V.), Humanitas University, Pieve Emanuele, Milan; Azienda Ospedaliero-Universitaria "Ospedali Riuniti" (A.B.), Trieste; and Azienda Socio Sanitaria Territoriale (M.Z.), Lecco, Italy.
出版信息
J Trauma Acute Care Surg. 2021 Jun 1;90(6):917-923. doi: 10.1097/TA.0000000000003182.
BACKGROUND
Preoperative identification of the cause of adhesive small bowel obstruction (ASBO) is crucial for decision making. Some computed tomography (CT) findings can be indicative of single adhesive bands or matted adhesions. Our aim was to build a predictive model based on CT data to discriminate ASBO due to single adhesive band or matted adhesions.
METHODS
A retrospective single center study was conducted, covering all consecutive patients with a preoperative CT scan, undergoing urgent surgery for ASBO between January 1, 2005, and December 31, 2017. Preoperative CT scans were blindly reviewed, and all the CT findings indicative of single adhesive band or matted adhesions described in literature were recorded. According to intraoperative findings, ASBOs were retrospectively classified into single band and matted ASBO. All observed CT findings were compared between the two groups. A predictive model based on logistic regression was developed, and its ability was quantified by discrimination and calibration. Internal cross-validation was conducted by bootstrap resampling.
RESULTS
A total of 116 patients were analyzed (males, 53.5%; median age, 68 years; single band ASBO in 65.5% of cases). The odds of single band ASBO were increased four times in presence of complete obstruction (odds ratios, 4.19; 95% confidence interval, 1.49-12.56) and seven times in presence of fat notch sign (odds ratios, 7.37; 95% confidence interval, 1.83-40.03). The predictive model combining all CT findings had an accuracy of 86% in single band ASBO prediction. Accuracy decreased to 79% in the internal validation. Sensitivity, specificity, and positive and negative predictive values were calculated at different cut-points of the predicted risk: using a 0.70 cut-point, the specificity is 80%, the sensitivity is 68%, and the positive and negative predictive values are 87% and 57%, respectively.
CONCLUSION
The proposed predictive model based on combination of specific CT findings may elucidate whether ASBO is caused by single bands or matted adhesions and, consequently, influence the clinical pathway.
LEVEL OF EVIDENCE
Prognostic study, level IV.
背景
术前识别粘连性小肠梗阻（ASBO）的病因对于决策至关重要。一些计算机断层扫描（CT）表现可能提示单一粘连带或粘连网。我们的目的是基于 CT 数据建立一个预测模型，以区分由单一粘连带或粘连网引起的 ASBO。
方法
本研究为回顾性单中心研究，纳入 2005 年 1 月 1 日至 2017 年 12 月 31 日期间因 ASBO 行急诊手术且术前有 CT 扫描的所有连续患者。术前 CT 扫描由盲法评估，记录文献中描述的所有提示单一粘连带或粘连网的 CT 表现。根据术中发现，ASBO 被回顾性分为单一带和粘连网型 ASBO。比较两组间所有观察到的 CT 表现。建立基于逻辑回归的预测模型，并通过判别和校准来量化其能力。采用 bootstrap 重采样进行内部交叉验证。
结果
共分析了 116 例患者（男性占 53.5%，中位年龄为 68 岁，单一带型 ASBO 占 65.5%）。完全梗阻时发生单一带型 ASBO 的可能性增加 4 倍（优势比，4.19；95%置信区间，1.49-12.56），存在脂肪切迹征时发生单一带型 ASBO 的可能性增加 7 倍（优势比，7.37；95%置信区间，1.83-40.03）。结合所有 CT 表现的预测模型在单一带型 ASBO 预测中的准确率为 86%。内部验证中准确率降至 79%。在不同预测风险截断点计算了敏感性、特异性、阳性和阴性预测值：使用 0.70 的截断点，特异性为 80%，敏感性为 68%，阳性和阴性预测值分别为 87%和 57%。
结论
基于特定 CT 表现组合的预测模型可能阐明 ASBO 是否由单一粘连带或粘连网引起，并因此影响临床路径。
证据水平
预后研究，IV 级。
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