Predictive Value of CT Enterography Index for Postoperative Intra-abdominal Septic Complications in Patients With Crohn's Disease: Implications for Surgical Decision-Making
Predictive Value of CT Enterography Index for Postoperative Intra-abdominal Septic Complications in Patients With Crohn's Disease: Implications for Surgical Decision-Making
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CT 小肠造影指数对克罗恩病患者术后腹腔内化脓性并发症的预测价值：对手术决策的影响
DOI：
10.1097/dcr.0000000000001796
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发表时间：
2021
影响因子：
3.9
通讯作者：
Zhu Weiming
中科院分区：
文献类型：
--
作者：
Wang Kehao;Huang Liangyu;Huang Wei;Liu Ruiqing;Chen Xintong;Guo Zhen;Qian Wenwei;Yin Yi;Li Yi;Zhu Weiming
背景：克罗恩病患者行肠切除吻合术后，术后并发脓毒症是一种常见且难以处理的并发症。目的：本研究旨在探讨CT肠造影术前预测腹内败血症并发症的价值。设计：这是一项回顾性和前瞻性的观察研究。设置：本研究是在一家三级转诊医院进行的。患者：本研究纳入克罗恩病行一期肠切除的患者。主要观察指标：计算CT肠造影术严重程度指数，并通过多因素分析评价其预测腹内败血症并发症的能力。结果：接受1期手术的患者术后腹内脓毒症的发生率显著高于接受2期手术的患者(3/103vs24/241；2.9%vs10.0%；p=0.026)。多因素分析发现，肠系膜纤维脂肪增生、腹内脓肿或痰肿、肠瘘、腹水、肠管扩张伴狭窄等5个CT肠造影参数是腹内脓毒症并发症的独立预测因素(p<；0.001)。建立了基于这5个参数的诺模图模型。受试者操作特征分析确定CT肠造影术评分为175分可作为预测腹内脓毒症并发症的指标，灵敏度为83.3%，特异度为85.3%。在前瞻性研究中，CT肠造影术评分为175分的患者被分配到二期组，其腹部内脓毒症并发症的发生率与接受肠切除加吻合或不吻合的患者相似(2/82vs2/34；p=0.355)。限制：这项研究受到单中心范围的限制。结论：术前CT肠造影术前发现可以预测克罗恩病的术后结果，并有助于确定手术方式。经CT肠造影术证实腹内病变较差的患者，可能受益于肠切除后的造口。请参阅https://links.上的视频摘要LWW。COM/DCR/B588。
BACKGROUND:Postoperative intra-abdominal septic complications in patients with Crohn’s disease undergoing intestinal resection and anastomosis are frequent and difficult to manage.OBJECTIVE:This study sought to explore the value of preoperative CT enterography to predict intra-abdominal septic complications.DESIGN:This was a retrospective and prospective observational study.SETTINGS:This study was conducted in a tertiary referral hospital.PATIENTS:Patients with Crohn’s disease undergoing primary intestinal resection were enrolled in our study.MAIN OUTCOME MEASURES:The CT enterography severity index was calculated and its ability to predict intra-abdominal septic complications evaluated by multivariate analyses. A prospective study was then performed to assess the reliability of this CT enterography index.RESULTS:The incidence of postoperative intra-abdominal septic complications in patients undergoing a 1-stage procedure was significantly higher than those undergoing a 2-stage procedure (3/103 vs 24/241; 2.9% vs 10.0%; p= 0.026). A multivariate analysis identified 5 CT enterography parameters, including mesenteric fibrofatty proliferation, intra-abdominal abscess or phlegmon, intestinal fistula, peritoneal effusion, and intestinal dilatation with stricture to be independent predictors of intra-abdominal septic complications (p< 0.001). A nomogram model based on these 5 parameters was constructed. A receiver operating characteristic analysis identified a CT enterography nomogram score cutoff of 175 as a predictor of intra-abdominal septic complications with a sensitivity of 83.3% and a specificity of 85.3%. In the prospective study, those patients with a CT enterography nomogram score> 175 were assigned to the 2-stage group, which resulted in a similar intra-abdominal septic complication incidence in those undergoing intestinal resection with or without anastomosis (2/82 vs 2/34; p= 0.355).LIMITATIONS:This study was limited by its single-center scope.CONCLUSIONS:Preoperative CT enterography findings may predict postoperative outcomes and help determine surgical approach in Crohn’s disease. Patients with worse intra-abdominal findings confirmed by CT enterography may benefit from stoma creation after intestinal resection. See Video Abstract at https://links. lww. com/DCR/B588.