Kudou Kensuke, Kawazoe Tetsuro, Nakanoko Tomonori, Ando Koji, Oki Eiji, Yoshizumi Tomoharu
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Surgery, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan.
Surg Today. 2025 Aug 20. doi: 10.1007/s00595-025-03121-y.
Strangulated bowel obstruction is a critical condition requiring emergency surgery. This study investigated the clinical parameters of patients undergoing emergency surgery for strangulated and non-strangulated bowel obstructions and identified the predictive factors for intestinal ischemia.
This retrospective review included 270 patients who underwent surgery for bowel obstruction. The clinical and operative factors were analyzed to determine the predictive factors for intestinal ischemia. A novel predictive scoring system was developed based on significant parameters identified by a multivariate analysis.
Among patients with strangulated bowel obstruction, independent predictors for the need for intestinal resection were massive ascites, computed tomography value ≤ 50 Hounsfield units, lactate levels ≥ 30 mg/dL, and neutrophil-lymphocyte ratio ≥ 8.5. A novel predictive score was developed using these four parameters. Patients with a score of 0 did not require intestinal resection because of strangulation. Fifteen patients, with a score of 7, developed irreversible ischemia and required intestinal resection.
A predictive score incorporating ascites, computed tomography values, lactate levels, and neutrophil-lymphocyte ratio effectively stratified patients with strangulated bowel obstruction, aiding early diagnosis and risk stratification.
绞窄性肠梗阻是一种需要紧急手术的危急病症。本研究调查了因绞窄性和非绞窄性肠梗阻接受急诊手术患者的临床参数，并确定了肠道缺血的预测因素。
这项回顾性研究纳入了270例接受肠梗阻手术的患者。分析临床和手术因素以确定肠道缺血的预测因素。基于多变量分析确定的显著参数开发了一种新的预测评分系统。
在绞窄性肠梗阻患者中，肠道切除必要性的独立预测因素为大量腹水、计算机断层扫描值≤50亨氏单位、乳酸水平≥30mg/dL以及中性粒细胞与淋巴细胞比值≥8.5。利用这四个参数开发了一种新的预测评分。评分为0的患者因绞窄无需肠道切除。15例评分为7的患者发生了不可逆缺血并需要肠道切除。
结合腹水、计算机断层扫描值、乳酸水平和中性粒细胞与淋巴细胞比值的预测评分有效地对绞窄性肠梗阻患者进行了分层，有助于早期诊断和风险分层。
