Multivariate Analysis about Surgical Indications for Adhesive Ileus_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Kongwang ¹ , ZHU Huagang ¹ , GENG Xiaoping ² , MENG Xiangling ¹

1.Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China;;
2.Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei 230032, China;

Corresponding author：

Keywords：

Adhesive ileus; Surgical indication; Logistic regression

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Objective To approach the convenient prediction methods about surgical indications of adhesive ileus.
Methods Two thousand and thirtyfour patients with adhesive ileus were analyzed retrospectively between January 1996 and January 2010 in the Department of General Surgery, The First Affiliated Hospital of Anhui Medical University， and 1 992 patients were included into this model. Seventeen factors which could influence the surgical decisions, including period of intestinal obstruction (X1), frequency of attack (X2), history of operation on abdominal region (X3), continuous and severe abdominal pain (X4), severe or frequent vomiting (X5), severe abdominal distention (X6), hemafecia (X7), fever (X8), heart rate (X9), shock or hypotension (X10), touching a swell ansa intestinalis (X11), hypoactive bowel sound (X12), peritonitis (X13), white blood cell (WBC) count of peripheral blood (X14), obstruction ansa interstinalis fixation and a severe expansion by abdominal erect position plain film (X15), peritoneal cavity free air (X16), and seroperitoneum whether or not by B ultrasonic examination (X17) were analyzed by binary logistic regression. Then prediction schedule whether patients with adhesive ileus needed emergency operation was gained by the theory of logistic regression analysis.
Results Eight items were included in the prediction model by the method of forward stepwise which were X1, X2, X4, X9, X13, X14, X15, and X17, respectively. The probability of operation could be calculated by the following formula: logit(P)=expZ/（1+expZ）, where, Z={-7.813+〔-1.942×X1(1)/2.290×X1(2)/2.765×X1(3)〕+2.801×X2+2.692×X4+10.610×X9(1)/13.279×X9(2)+3.422×X13+〔-3.048×X14(1)/16.992×X14(2)〕+6.113×X15+2×X17}， which X1（1）, X1（2）, and X1（3） were periods of intestinal obstruction 3－5 d, 5－7 d, and ≥7 d, respectively. X9(1) and X9(2) were heart rates of 60－100/min and ≥100/min, respectively. X14(1) and X14(2) were WBC counts of peripheral blood of (10-20)×109/L and ≥20×109/L， respectively. The patient had to accept surgical procedure when the value of P was more than 0.5. The coincidence was 99.00%, sensitivity was 96.17%, specificity was 99.53% in 1 992 patients. The coincidence was 96.20%, sensitivity was 90.00%, specificity was 96.84% in 105 patients between January 2010 and April 2010 in this hospital.
Conclusion The prediction schedule is a good useful value, but the coefficients is corrected following the cases increasing.

Citation： HU Kongwang ,ZHU Huagang,GENG Xiaoping,MENG Xiangling. Multivariate Analysis about Surgical Indications for Adhesive Ileus. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(9): 939-943. doi: Copy

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1. Foster NM, McGory ML, Zingmond DS, et al. Small bowel obstruction: a populationbased appraisal [J]. J Am Coll Surg, 2006; 203(2): 170176.
2. 张文彤. SPSS 11统计分析教程（高级篇） [M]. 北京: 北京希望电子出版社, 2002: 91107.
3. 陈平雁，黄浙明. SPSS 8.0统计软件应用教程 [M]. 北京: 人民军医出版社, 2002： 230240.
4. 倪宗瓒. 医学统计学 [M]. 北京: 人民卫生出版社, 1990: 229233.
5. Tabibian JH. Management of highgrade smallbowel obstruction [J]. Arch Surg, 2010; 145(4): 404405.
6. Saleem MM, AlMomani H, Abu Khalaf M. Intussusception: Jordan University Hospital experience [J]. Hepatogastroenterology, 2008; 55(85): 13561359.
7. Cheynel N, Cortet M, Lepage C, et al. Trends in frequency and management of obstructing colorectal cancers in a welldefined population [J]. Dis Colon Rectum, 2007; 50(10): 15681575.
8. Park J, LaBella G, McDonough S, et al. A stercoral sigmoid ulcer masquerading as perforated diverticulitis [J]. Am Surg, 2010; 76(3): 346347.
9. Raphaeli T, Parimi C, Mattix K, et al. Acute colonic obstruction from Ladd bands: a unique complication from intestinal malrotation [J]. J Pediatr Surg, 2010; 45(3): 630631.
10. Villalona GA, Diefenbach KA, Touloukian RJ. Congenital and acquired mesocolic hernias presenting with small bowel obstruction in childhood and adolescence [J]. J Pediatr Surg, 2010; 45(2): 438442.
11. Serafimidis C, Katsarolis I, Vernadakis S, et al. Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon) [J]. BMC Surg, 2006; 13(6): 3.
12. 邓兰树, 沈文律, 文军, 等. 广泛粘连性肠梗阻的再手术治疗（附28例报告） [J]. 中国普外基础与临床杂志, 2002; 9(4): 275276.
13. 潘雷. 149例粘连性肠梗阻诊治体会 [J]. 中国普外基础与临床杂志, 2002; 9(6): 434435.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Multivariate Analysis about Surgical Indications for Adhesive Ileus

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