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中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 521 -524. doi: 10.3877/cma.j.issn.1674-3946.2021.05.015

论著

老年急性结石性胆囊炎手术时机危急值评判
赵月1, 张宗明1,(), 刘立民1, 张翀1, 刘卓1, 朱明文1, 邓海1, 万柏江1, 谢希源1, 张李鹏2   
  1. 1. 100073 北京,国家电网公司北京电力医院普外科
    2. 100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院胰胃外科
  • 收稿日期:2020-10-09 出版日期:2021-10-26
  • 通信作者: 张宗明

Clinical analysis of the critical indicators of surgical timing for senile patientswith acute calculous cholecystitis

Yue Zhao1, Zongming Zhang1,(), Limin Liu1, Chong Zhang1, Zhuo Liu1, Mingwen Zhu1, Hai Deng1, Baijiang Wan1, Xiyuan Xie1, Lipeng Zhang2   

  1. 1. Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
    2. Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Received:2020-10-09 Published:2021-10-26
  • Corresponding author: Zongming Zhang
  • Supported by:
    Grants from Beijing Municipal Science & Technology Commission(Z171100000417056)
引用本文:

赵月, 张宗明, 刘立民, 张翀, 刘卓, 朱明文, 邓海, 万柏江, 谢希源, 张李鹏. 老年急性结石性胆囊炎手术时机危急值评判[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(05): 521-524.

Yue Zhao, Zongming Zhang, Limin Liu, Chong Zhang, Zhuo Liu, Mingwen Zhu, Hai Deng, Baijiang Wan, Xiyuan Xie, Lipeng Zhang. Clinical analysis of the critical indicators of surgical timing for senile patientswith acute calculous cholecystitis[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(05): 521-524.

目的

探讨老年急性结石性胆囊炎(ACC)手术时机危急值,以期指导临床准确把握手术时机。

方法

回顾性分析2013年7月至2020年6月192例老年ACC手术患者的临床资料。根据ACC危急程度分为重症急性胆囊炎(SAC)组和非重症急性胆囊炎(NSAC)组。采用SPSS 21.0软件进行统计学处理。单因素分析采用χ2检验,多因素Logistic回归分析确定独立危险因素。采用ROC曲线确定截断值,并计算曲线下面积。P<0.05表示差异有统计学意义。

结果

单因素分析显示SAC组较NSAC组患者体温≥ 38.5℃、白细胞计数≥ 15×109/L、中性粒细胞比例≥ 85.0%、高敏C反应蛋白≥ 100 mg/L、B超发现胆囊壁双边征、CT或MRI显示胆囊周围和肝周积液的比例显著增加(P<0.05)。以高敏C反应蛋白≤3 mg/L为参照设置哑变量,进一步校正混杂因素后,多因素Logistic回归提示高敏C反应蛋白≥100 mg/L、中性粒细胞比例≥85.0%为老年SAC的独立危险因素,ROC曲线显示二者的截断值分别为77.3 mg/L和82.4%。

结论

高敏C反应蛋白77.3 mg/L和中性粒细胞比例82.4%,可以作为老年ACC手术时机的危急值,据此准确把握手术时机,对于提高老年ACC手术治疗效果具有关键作用。

Objective

To investigate the critical indicators of surgical timing for senile patients with acute calculous cholecystitis (ACC), so as to guide the clinical practice for accurate operation timing.

Methods

The clinical data of 192 senile patients with ACC from July 2013 to June 2020 were analyzed retrospectively. According to the severity of ACC, the patients were divided into two groups: severe acute cholecystitis (SAC) and non severe acute cholecystitis (NSAC). Statistical analysis were performed by using SPSS 21.0 software. Univariate analysis was performed by using chi-square test. The independent risk factors were analyzed by using multivariate logistic regression analysis . Receiver operating characteristic (ROC) curve were drawn to determine the cut-off value and to calculate the area under the curve. P value of <0.05 was considered as statistically significant difference.

Results

The univariate analysis showed that the significantly increased proportion of patients with body temperature of ≥ 38.5°C, peripheral WBC of ≥ 15×109/L, neutrophils of ≥ 85.0%, Hs-CRP of ≥ 100 mg/L, double layer structure of the gallbladder wall showed by B-ultrasonography, and pericholecystic or perihepatic fluid showed by CT or MRI in SAC group compared with NSAC group (P<0.05). After analyzing the confounding factors, multivariate Logistic regression showed that Hs-CRP of ≥ 100 mg/L and neutrophils fo ≥ 85.0% were independent risk factors for senile patients with SAC. The cut-off values of Hs-CRP of 77.3 mg/L and neutrophils of 82.4% were calculated respectively.

Conclusion

Hs-CRP of 77.3 mg/L and neutrophils of 82.4% could be used as the critical indicators of surgical timing for senile patients with ACC. According to this critical value, accurate surgical timing would play a key role in improving the therapeutic effect of senile patients with ACC.

表1 192例老年ACC不同危急程度两组患者临床资料对比分析[(±s),例]
表2 192例老年ACC不同危急程度两组患者手术治疗效果对比分析[(±s),例]
表3 192例老年ACC不同危急程度两组患者手术时机危急值单因素对比分析[例(%)]
表4 192例老年ACC不同危急程度手术时机的多因素Logistic回归分析
图1 高敏C反应蛋白(Hs-CRP)、中性粒细胞(N)评估老年ACC危险程度的ROC曲线
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