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

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。

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.