恶性肠梗阻手术风险的评估

ASSESSMENT OF THE RISK OF SURGERY FOR MALIGNANT BOWEL OBSTRUCTION

目的 评价联合应用急性生理学和慢性健康状况评分Ⅱ（APACHE-Ⅱ）、改良手术并发症和死亡率评分系统（POSSUM）手术侵袭度评分对恶性肠梗阻手术风险及预后的预警作用。方法 回顾性分析148例恶性肠梗阻手术病例,探讨其临床结果与评分系统的关系。结果 死亡组、并发症组和无并发症组APACHE-Ⅱ评分分别为17.69±5.06、12.72±4.55、9.03±3.36,组间比较差异均有显著性（F=10.65,q=4.16-8.44,P〈0.01）。死亡组、并发症组和无并发症组手术侵袭度评分分别为15.81±3.12、13.65±2.54、12.45±2.86,死亡组手术侵袭度评分高于并发症组和无并发症组（F=40.73,q=2.45、4.43,P〈0.05）。结论 APACHE-Ⅱ评分系统可较准确地评估恶性肠梗阻病人的手术风险和预后;改良POSSUM手术侵袭度评分可对恶性肠梗阻手术方式的选择起指导作用。

Objective To evaluate the operation risk and prognosis warning effect using both APACHE-Ⅱ and modified POSSUM scoring system on malignant bowel obstruction （MBO）. Methods A retrospective analysis of 148 cases of MBO was done to investigate the relationship between the clinical results and scoring system. Results The APACHE-Ⅱ scores of death group, complication group and no-complication were 17.69±5.06, 12.72±4.55, and 9.03±3.36, respectively, the differences be tween the three groups were statistically significant （F= 10.65, q= 4.16-8.44, P 〈0.01）; That of POSSUM in the death group, complication group and no-complication group were 15.81±3.12, 13.65±2.54, and 12.45±2.86, respectively （F=40.73;q=2.45, 4.43;P〈0.05）. Conclusion APACHE-Ⅱ scoring system can accurately assess the operation risk and prognosis of patients with MBO, and the modified POSSUM plays a guidance in the option of surgery for this condition.