Friziero Alberto, Rosso Eugenia, Zuin Irene Sole, Vallese Lorenzo, Serafini Simone, Amico Alessandra, Valli Valeria, Re Chiara Da, Baldan Nicola, Valmasoni Michele, Dalt Gianfranco Da, Sperti Cosimo
Department of Surgery, Oncology and Gastroenterology, 1st Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy.
Department of Surgery, Oncology and Gastroenterology, 2nd Surgical Clinic, University of Padua, Via Giustiniani 2, Padua, 35128, Italy.
BMC Surg. 2024 Jun 12;24(1):179. doi: 10.1186/s12893-024-02476-2.
Adhesive small bowel obstruction (ASBO) is a leading cause of hospitalization in emergency surgery. The occurrence of bowel ischemia significantly increases the morbidity and mortality rates associated with this condition. Current clinical, biochemical and radiological parameters have poor predictive value for bowel ischemia. This study is designed to ascertain predictive elements for the progression to bowel ischemia in patients diagnosed with non-strangulated ASBO who are initially managed through conservative therapeutic approaches.
The study was based on the previously collected medical records of 128 patients admitted to the Department of Acute Care Surgery of Padua General Hospital, from August 2020 to April 2023, with a diagnosis of non-strangulated adhesive small bowel obstruction, who were then operated for failure of conservative treatment. The presence or absence of bowel ischemia was used to distinguish the two populations. Clinical, biochemical and radiological data were used to verify whether there is a correlation with the detection of bowel ischemia.
We found that a Neutrophil-Lymphocyte ratio (NLR) > 6.8 (OR 2.9; 95% CI 1.41-6.21), the presence of mesenteric haziness (OR 2.56; 95% CI 1.11-5.88), decreased wall enhancement (OR 4.3; 95% CI 3.34-10.9) and free abdominal fluid (OR 2.64; 95% CI 1.08-6.16) were significantly associated with bowel ischemia at univariate analysis. At the multivariate logistic regression analysis, only NLR > 6.8 (OR 5.9; 95% CI 2.2-18.6) remained independent predictive factor for small bowel ischemia in non-strangulated adhesive small bowel obstruction, with 78% sensitivity and 65% specificity.
NLR is a straightforward and reproducible parameter to predict bowel ischemia in cases of non-strangulated adhesive small bowel obstruction. Employing NLR during reevaluation of patients with this condition, who were initially treated conservatively, can help the acute care surgeons in the early prediction of bowel ischemia onset.
粘连性小肠梗阻（ASBO）是急诊手术住院的主要原因。肠缺血的发生显著增加了与此病症相关的发病率和死亡率。目前的临床、生化和放射学参数对肠缺血的预测价值较差。本研究旨在确定在最初通过保守治疗方法进行管理的非绞窄性ASBO患者中，进展为肠缺血的预测因素。
该研究基于帕多瓦综合医院急性护理外科2020年8月至2023年4月收治的128例诊断为非绞窄性粘连性小肠梗阻患者的既往病历，这些患者随后因保守治疗失败而接受手术。根据是否存在肠缺血来区分这两组人群。临床、生化和放射学数据用于验证是否与肠缺血的检测存在相关性。
我们发现，在单因素分析中，中性粒细胞与淋巴细胞比值（NLR）>6.8（比值比[OR]2.9；95%置信区间[CI]1.41 - 6.21）、肠系膜模糊（OR 2.56；95% CI 1.11 - 5.88）、肠壁强化减弱（OR 4.3；95% CI 3.34 - 10.9）和腹腔游离液体（OR 2.64；95% CI 1.08 - 6.16）与肠缺血显著相关。在多因素逻辑回归分析中，只有NLR>6.8（OR 5.9；95% CI 2.2 - 18.6）仍然是非绞窄性粘连性小肠梗阻中小肠缺血的独立预测因素，敏感性为78%，特异性为65%。
NLR是预测非绞窄性粘连性小肠梗阻患者肠缺血的一个简单且可重复的参数。在对最初接受保守治疗的此类患者进行重新评估时使用NLR，可帮助急性护理外科医生早期预测肠缺血的发生。
