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疑似胃肠道穿孔手术探查阴性:趋势、术前预测因素及病因

Negative surgical exploration in suspected gastrointestinal perforation: trend, preoperative predictors, and etiologies.

作者信息

Liu Xuan, Sheng Weizhong, Gong Yuda, Gao Weidong, Zhang Bo

机构信息

Department of General Surgery, Zhongshan Hospital, Fudan University School of Medicine, Shanghai, China.

出版信息

Ann Transl Med. 2021 May;9(10):832. doi: 10.21037/atm-20-8158.

Abstract

BACKGROUND

Despite the rapid improvement of clinical science and imaging technology including computed tomography, the entity of negative surgical exploration in suspected gastrointestinal perforation (N-GIP) still exist. However, few studies have focused on this issue and most studies are case reports. We undertook this study to investigate the rates of N-GIP, and explore a set of possible preoperative predictors associated with N-GIP.

METHODS

This was a retrospective study performed at the department of general surgery in our treatment center. All patients included were suspected gastrointestinal perforation (GIP) cases, aged 14 years and over, and underwent emergency surgery between 2009 and 2019. A predictive multivariable model of the presence of N-GIP was developed using logistic regression analysis.

RESULTS

A total of 973 patients were identified and 30 (3.1%) were found to have no evidence of perforated gastrointestinal tract. The mean age of patients was 59.74 (range, 14-97) years, and 67.2 percent of the patients were males. The rates of N-GIP did not have a significant change over time (P=0.212 for trend). In multivariable analysis, absence of generalized peritonitis, duration of abdominal pain >19.6 hours, and neutrophil-to-lymphocyte ratio (NLR) <3.80 were significant predictors of N-GIP. N-GIP was more common in patients with gastrointestinal tumors and foreign bodies. Five patients (16.7%) in N-GIP group experienced complications and the 90-day mortality rate was 6.7%.

CONCLUSIONS

The rates of N-GIP did not change significantly over time. N-GIP was associated with the absence of generalized peritonitis, duration of abdominal pain >19.6 hours, and NLR <3.80.

摘要

背景

尽管包括计算机断层扫描在内的临床科学和成像技术迅速发展,但疑似胃肠道穿孔(N-GIP)的阴性手术探查情况仍然存在。然而,很少有研究关注这个问题,大多数研究都是病例报告。我们进行这项研究以调查N-GIP的发生率,并探索一组与N-GIP相关的术前预测因素。

方法

这是一项在我们治疗中心普通外科进行的回顾性研究。纳入的所有患者均为疑似胃肠道穿孔(GIP)病例,年龄在14岁及以上,于2009年至2019年间接受急诊手术。使用逻辑回归分析建立了N-GIP存在的预测多变量模型。

结果

共识别出973例患者,其中30例(3.1%)未发现胃肠道穿孔的证据。患者的平均年龄为59.74岁(范围为14 - 97岁),67.2%的患者为男性。N-GIP的发生率随时间没有显著变化(趋势P = 0.212)。在多变量分析中,无弥漫性腹膜炎、腹痛持续时间>19.6小时以及中性粒细胞与淋巴细胞比值(NLR)<3.80是N-GIP的显著预测因素。N-GIP在胃肠道肿瘤和异物患者中更常见。N-GIP组有5例患者(16.7%)出现并发症,90天死亡率为6.7%。

结论

N-GIP的发生率随时间没有显著变化。N-GIP与无弥漫性腹膜炎、腹痛持续时间>19.6小时以及NLR <3.80有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c12/8184416/75de31629dc0/atm-09-10-832-f1.jpg

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