The Choice Of Operation Time For Adult Acute Fecal Stone Obstruction Of Small Intestine

OBJECTIVE: To explore the best operation time of adult acute fecal stone obstruction of small intestine.METHODS: a retrospective study was conducted on 84 cases of adult acute fecal stone obstruction admitted to the Affiliated Hospital of Guilin Medical College from March 2008 to February 2020.According to the treatment mode of the patients,they were divided into two groups,including 48 cases in the conservative treatment group and 36 cases in the surgical treatment group.The relevant clinical data of each group were collected,and single factor and multi factor Logistic linear regression analysis were used to analyze the possible influencing factors of operation timing of adult acute fecal stone small bowel obstruction.The R language software was used to draw the nomogram of surgical risk of adult patients with acute faecal stone obstruction of small intestine,and Bootstrap Method(1000 times of resampling)was used to verify the fitting degree of the model internally.The accuracy of the prediction was evaluated by the Harrell's concordance index(c-index),and the calibration curve and the ROC curve of the operative risk were drawn.RESULTS: According to the results of single factor analysis,there were six factors related to the choice of operation time in the two groups,including the location of fecal stone incarceration,the time of conservative treatment,whether there was peritoneal effusion,whether there was continuous abdominal pain,whether the intestinal tract was expanded,whether the leukocyte count was increased,and the results had statistical significance(P < 0.05).According to the multivariate logistic regression analysis,all of the above factors were related to the timing of operation for adult acute fecal stone obstruction(P < 0.05).The Harrell's concordance index of nomogram of surgical risk in adult patients with acute faecal stone obstruction of small intestine was 0.947,which indicated that the nomogram had a high predictive accuracy.Conclusion: For adult patients with acute faecal stone obstruction,the location of faecal stone incarceration,the time of conservative treatment,whether there was peritoneal effusion,whether there was persistent abdominal pain,whether the intestinal tract was expanded,whether the leukocyte count was increased were all factors that affecting the timing of operation.When the fecal stone was located in the distal small intestine,the conservative treatment time was more than 3 days,CT showed that there was ascites,the patient had persistent abdominal pain,the degree of intestinal expansion was ? 3.7cm and the white blood cell count increased,the positive surgical treatment should be considered.The surgical risk can be evaluated by the nomogram.Results of this study provided an important reference for the choice of treatment scheme.