医学新知2024,Vol.34Issue(5) :523-529.DOI:10.12173/j.issn.1004-5511.202402014

复杂性急性阑尾炎腹腔镜术后并发肠梗阻的影响因素及其预测价值分析

Analysis of influencing factors and predictive values for ileus after laparoscopic surgery for complicated acute appendicitis

史梦奇 高磊 吴冲 刘栋 刘寒松
医学新知2024,Vol.34Issue(5) :523-529.DOI:10.12173/j.issn.1004-5511.202402014

复杂性急性阑尾炎腹腔镜术后并发肠梗阻的影响因素及其预测价值分析

Analysis of influencing factors and predictive values for ileus after laparoscopic surgery for complicated acute appendicitis

史梦奇 1高磊 2吴冲 2刘栋 2刘寒松2
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作者信息

  • 1. 新乡医学院(河南新乡 453003);郑州大学附属郑州中心医院胃肠、疝和腹壁外科(郑州 450007)
  • 2. 郑州大学附属郑州中心医院胃肠、疝和腹壁外科(郑州 450007)
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摘要

目的 研究复杂性急性阑尾炎(complicated acute appendicitis,CAA)患者腹腔镜阑尾切除术后并发肠梗阻(postoperative ileus,POI)的影响因素.方法 回顾性收集2022年9月-2023年12月就诊于郑州市中心医院的CAA患者临床资料,根据腹腔镜阑尾切除术后临床症状和影像学分为POI组和非POI组.采用Logistic回归分析CAA患者术后并发POI的影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线探究相关指标的预测价值.结果 共纳入153例CAA患者,其中POI组15例,非POI组138例.单因素分析结果显示,POI组与非POI组在年龄、腹部手术史、术前全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)、白细胞计数(white blood cell,WBC)、白蛋白计数(albumin,ALB)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)和术后留置引流管的差异有统计学意义(P<0.05).Logistic 回归分析结果显示,术前 SIRS[OR=31.212,95%CI(2.012,484.090),P<0.05]、WBC 升高[OR=1.328,95%CI(1.048,1.682),P<0.05]和NLR 升高[OR=1.430,95%CI(1.114,1.837),P<0.05]是 CAA 患者腹腔镜阑尾切除术后并发 POI 的危险因素,ALB 升高[OR=0.734,95%CI(0.565,0.953),P<0.05]是术后并发POI的保护因素.ROC曲线分析结果显示,WBC、NLR、ALB预测CAA患者术后并发POI的曲线下面积分别为0.842[95%CI(0.756,0.927),P<0.001]、0.904[95%CI(0.831,0.978),P<0.001)、0.845[95%CI(0.734,0.956),P<0.001].结论 CAA患者术前合并SIRS、高WBC、高NLR、低ALB会增加腹腔镜阑尾切除术后并发POI的风险,WBC、NLR、ALB对CAA患者腹腔镜阑尾切除术后并发POI具有较高的预测价值.

Abstract

Objective To investigate the influencing factors of postoperative ileus(POI)complicated after laparoscopic surgery in patients with complicated acute appendicitis(CAA).Methods The clinical data of CAA patients attending Zhengzhou Central Hospital from September 2022 to December 2023 were retrospectively collected,and divided into the POI group and the non-POI group according to the postoperative clinical symptoms and imaging.Logistic regression was used to analyze the influencing factors of CAA complicating POI,and the predictive values of related factors were explored using the receiver operating characteristic(ROC)curve.Results 153 CAA patients were included,with 15 in the POI group and 138 in the non-POI group.In the univariate analysis,the differences in age,history of abdominal surgery,preoperative systemic inflammatory response syndrome(SIRS),white blood cell(WBC),albumin(ALB),neutrophil/lymphocyte ratio(NLR),and postoperative indwelling drain between the POI group and the non-POI group were statistically significant(P<0.05).In the Logistic regression analysis,preoperative SIRS[OR=31.212,95%CI(2.012,484.090),P<0.05],elevated WBC[OR=1.328,95%CI(1.048,1.682),P<0.05]and elevated NLR[OR=1.430,95%CI(1.114,1.837),P<0.05]were risk factors for concomitant POI in CAA patients,and elevated ALB[OR=0.734,95%CI(0.565,0.953),P<0.05]was a protective factor for concomitant POI.In the ROC curve analysis,the areas under the curve of WBC,NLR,and ALB were 0.842[95%CI(0.756,0.927),P<0.001)],0.904[95%CI(0.831,0.978),P<0.001],and 0.845[95%CI(0.734,0.956),P<0.001],respectively.Conclusion Preoperative complications with SIRS,high WBC,high NLR,and low ALB in CAA patients increase the risk of POI.WBC,NLR,and ALB have high predictive value for complications of POI in CAA patients.

关键词

复杂性急性阑尾炎/腹腔镜阑尾切除术/术后肠梗阻/影响因素

Key words

Complicated acute appendicitis/Laparoscopic appendectomy/Postoperative ileus/Influencing factors

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基金项目

河南省医学科技攻关计划联合共建项目(LHGJ20191053)

出版年

2024
医学新知
武汉大学中南医院,中国农工民主党湖北省委医药卫生工作委员会

医学新知

CSTPCD
影响因子:0.243
ISSN:1004-5511
参考文献量25
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