CT 分级表在决定对疑似小肠梗阻患者进行外科干预时的实用性

IF 1.4 Q3 SURGERY Surgery open science Pub Date : 2024-05-31 DOI:10.1016/j.sopen.2024.05.016
Marianne Becnel , Ikaikaolahui Danner , Maria De Los Santos , Lindsay J. Escobedo , Marie Mohrbacher , Jacob Young , Robert Patterson
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引用次数: 0

摘要

背景为评估疑似小肠梗阻(SBO)患者的计算机断层扫描(CT)制定了一套分级系统。我们假设,CT 扫描中疑似 SBO 等级较高的患者更有可能需要手术治疗。方法对急诊室(ER)中因疑似 SBO 而接受腹部和盆腔 CT 检查的患者进行回顾性病历审查。患者分为 5 组:结果对 655 名患者的 CT 扫描结果进行了分级。在 22 名 1 级 SBO 患者中,只有 1 人接受了手术(4.5%)。二级 SBO 患者 299 人中有 23 人接受了手术(7.7%),三级 SBO 患者 299 人中有 84 人接受了手术(28.1%),四级 SBO 患者 35 人中有 25 人接受了手术(71.4%)。P值为<0.00001。术中最常见的三种发现是单纯粘连引起的 SBO 梗阻(占 48%),其次是嵌顿疝 (12%)和缺血性肠管(9%)。结论 本院制定的 SBO CT 分级表显示,分级与是否手术之间存在很好的相关性,很少出现负面结果,可作为普外科医生决定是否为疑似 SBO 患者手术的有用工具。
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The utility of a CT grading scale in deciding on surgical intervention for patients with suspected small bowel obstruction

Background

A grading system was developed for computerized tomography (CT) scans evaluating patients with suspected small bowel obstruction (SBO). We hypothesized that patients with a higher grade of suspected SBO on CT scan would be more likely to require surgical intervention.

Methods

Retrospective chart review of patients who presented to the Emergency Room (ER) who had a CT of the abdomen and pelvis for suspected SBO. Patients were divided into 5 groups: Grade 1 (SBO unlikely), Grade 2 (probable partial or early SBO), Grade 3 (probable high grade SBO), Grade 4 (SBO with changes concerning for ischemia) and Not Graded.

Results

The CT scans of 655 patients were graded. Of the 22 patients with a grade 1 SBO, only 1 went for surgery (4.5 %). For grade 2 patients, 23 out of 299 had an operation (7.7 %), for grade 3 it was 84 out of 299 (28.1 %) and for grade 4 SBO, 25 out of 35 patients (71.4 %) had surgery. The p value is <0.00001. The three most common intraoperative findings were SBO obstruction from adhesions alone (48 % of cases), followed by incarcerated hernias (12 %) and ischemic bowel (9 %). Only 8 cases out of 133 operations (6 % of total) had no findings at time of surgery other than dilated bowel.

Conclusions

The CT grading scale for SBO developed at our institution shows excellent correlation between grade and going for surgery, with few negative results, and can be a useful tool among other factors for general surgeons when deciding whether or not to operate on a patient with suspected SBO.

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CiteScore
1.30
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