梗阻过渡区CT特征对粘连性小肠梗阻病人保守治疗效果的预测价值OA

Objective To investigate the predictive value of computed tomography(CT)features at the transition zone in adhesive small bowel obstruction(ASBO)for the outcome of conservative treatment,and to provide imaging-based evidence for clinical decision-making.Methods Clinical and CT imaging data of 235 patients with ASBO were retrospectively analyzed.Based on the treatment modality,patients were divided into the conservative treatment success group(n=170)and the non-success group(n=65).Two radiologists independently analyzed the location of the transition zone,adhesion morphology at the transition zone,degree of obstruction,and small bowel feces sign on CT images.Interobserver agreement was assessed using Cohen's Kappa coefficient.Comparisons of general characteristics and CT features between the two groups were performed using the t test and chi-square test.Univariate and multivariate logistic regression analyses were used to identify CT features influencing the outcome of conservative treatment,and predictive models based on individual features and their combination were constructed.Receiver operating characteristic(ROC)curves were used to evaluate model performance,and the area under the curve(AUC)was calculated.Results Interobserver agreement for all evaluated CT features at the transition zone was excellent(all κ>0.85).The conservative treatment success group showed significantly higher proportions of small bowel feces sign and angled adhesion compared with the non-success group,whereas complete obstruction and band-like impression were more frequent in the non-success group(all P<0.05).Multivariate analysis revealed that small bowel feces sign(OR=3.307)was an independent protective factor for successful conservative treatment,while band-like impression(OR=0.192)and complete obstruction(OR=0.225)were independent risk factors(all P<0.05).Among the individual-feature models and the combined model incorporating all three features,the combined model demonstrated the highest predictive performance(AUC=0.764).Conclusion Identification of CT features at the transition zone in adhesive small bowel obstruction can effectively predict the outcome of conservative treatment,thereby facilitating optimization of clinical management strategies.