腹膜刺激征联合CT平扫特征表现对绞窄性与非绞窄性小肠梗阻的鉴别诊断价值

Value of peritoneal irritation sign combined with distinctive manifestations of plain CT scan on the differential diagnosis of strangulated and non-strangulated small bowel obstruction

目的探讨腹膜刺激征联合CT平扫特征表现对绞窄性与非绞窄性小肠梗阻的鉴别诊断价值。方法回顾性分析199例小肠梗阻患者的临床资料,其中绞窄性小肠梗阻93例(观察组)、非绞窄性小肠梗阻106例(对照组)。比较两组患者临床症状和体征、实验室指标、CT平扫特征表现的差异。采用Logistic回归模型筛选与绞窄性小肠梗阻相关的因素,并建立联合鉴别模型。采用受试者工作特征(ROC)曲线分析腹膜刺激征、CT平扫特征表现单独及联合鉴别绞窄性与非绞窄性小肠梗阻的价值。结果与对照组相比,观察组存在腹膜刺激征者比例、白细胞计数、中性粒细胞绝对值、肠液CT值、肠壁密度增高比例、肠壁增厚比例、系膜水肿比例、腹腔积液比例、结肠塌陷比例均更高,肠管直径更小(均P<0.05)。Logistic回归分析结果显示,腹膜刺激征、肠壁密度增高、系膜水肿、结肠塌陷与绞窄性小肠梗阻相关(均P<0.05)。ROC曲线分析显示,腹膜刺激征联合肠壁密度增高、系膜水肿、结肠塌陷鉴别诊断绞窄性和非绞窄性小肠梗阻的曲线下面积为0.815,灵敏度为72.0%,特异度为81.1%,曲线下面积均大于上述单一CT平扫特征表现(均P<0.05)。结论腹膜刺激征联合CT平扫特征表现肠壁密度增高、系膜水肿、结肠塌陷可提高鉴别绞窄性与非绞窄性小肠梗阻的准确性。

Objective To investigate the value of peritoneal irritation sign combined with plain CT scan distinctive manifestations on the differential diagnosis of strangulated and non-strangulated small bowel obstruction.Methods The clinical data of 199 patients with small bowel obstruction were analyzed retrospectively,among which there were 93 patients with strangulated small bowel obstruction(the observation group),and 106 patients with non-strangulated small bowel obstruction(the control group).The differences of clinical symptoms,physical signs,laboratory indices,and plain CT scan distinctive manifestations were compared between the two groups.The factors related to strangulated small bowel obstruction were screened by the Logistic regression model,and the combined differential model was constructed.The values of peritoneal irritation sign and plain CT scan distinctive manifestations alone and jointly for differentiating strangulated and non-strangulated small bowel obstruction were analyzed by the receiver operating characteristic(ROC)curve.Results Compared with the control group,the observation group exhibited a higher proportion of presence of patients with peritoneal irritation sign,and higher white blood cell counts,absolute value of neutrophils,CT value of succus entericus,as well as higher proportions of intestinal wall density increase,intestinal wall thickening,mesangial edema,seroperitoneum,and colonic collapse,whereas smaller diameter of intestinal canal(all P<0.05).The results of Logistic regression analysis revealed that peritoneal irritation sign,increase of intestinal wall density,mesangial edema,and colonic collapse were related to strangulated small bowel obstruction(all P<0.05).The results of ROC curve showed that the area under the curve of peritoneal irritation sign combined with increase of intestinal wall density,mesangial edema,and colonic collapse for differentially diagnosing strangulated and non-strangulated small bowel obstruction was 0.815,the sensitivity was 72.0%,the specificity was 81.1%,and the area under the curve was larger than that of the single distinctive manifestations of plain CT scan as above(all P<0.05).Conclusion Peritoneal irritation sign combined with plain CT scan distinctive manifestations suggests that increase of intestinal wall density,mesangial edema,and colonic collapse can improve the differential accuracy of strangulated and non-strangulated small bowel obstruction.