关键词: 肠梗阻, 肠癌, 克罗恩病, 肿瘤标记物, 列线图

Abstract: The establishment of a predictive model for cancerous intestinal obstruction and the clinical analysis of cancerous and Crohn's disease associated obstruction        DUAN Ming *, WU En-hao , CAO Lei, et al.*Department of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China; Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
Corresponding author: ZHU Wei-ming ，E-mail：juwiming@nju.edu.cn.
Abstract    Objective    To investigate the clinical differential diagnosis and different treatment principles of cancerous intestinal obstruction and Crohn's disease (CD) associated intestinal obstruction. Methods    Data of 406 patients with  intestinal obstruction from January 2015 to December 2019 in the Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, were retrospectively included.According to the etiology, the patients with cancerous intestinal obstruction and CD associated intestinal obstruction were divided into cancer group (63 cases) and CD group (183 cases). The differences of clinical and abdominal CT-related indexes between the two groups were compared. Multivariate logistic regression analysis was performed to establish and verified the predictive model of cancerous obstruction. Results    In the cancer group, the onset age was higher (54.9±2.2 vs. 39.9±1.0 years, t=-6.3, P <0.01), and the disease duration was shorter than that of the CD group (12.9±1.6 vs. 26.3±3.1 weeks, t=3.8，P<0.01).  In cancer group, the incidence of vomiting, abdominal distention, less flatus and stool and emergency surgery were significantly higher than those in CD group ［39 (61.9%) vs. 16 (8.7%)，χ2=78.0, P<0.01; 58(92.1%) vs. 82(44.8%)，χ2=44.9, P<0.01; 53 (84.1%) vs. 61 (33.3%)，χ2=50.6, 45 (71.4%) vs. 17 (9.3%)，χ2=98.1, P<0.01］. The increased extent and number of tumor markers in the cancer group were significantly higher than those of the CD group ［2.3(1.1-15.6) vs. 1.5(1.0-4.0)，Z=-2.5, P=0.014; 1.0(1.0-5.0) vs. 1.0(1.0-2.0)，Z=-4.8, P<0.01］. The bowel wall thickness (11.5±0.5 vs. 7.5±0.2 mm，t=-6.9, P<0.01) and the proximal and distal diameter ratio［3.7(1.9-13.8) vs. 3.0(1.3-11.2)，Z=-3.3, P<0.01］ of the cancer group were higher than those of the CD group, and the diameter of the intestinal stenosis ［3.0(1.0-6.0)mm vs. 5.0(2.0-9.8)mm，Z=-4.9, P<0.01］ was significantly smaller than that of the CD group. Based on the logistic multivariate analysis and step regression, the predictive model of cancerous intestinal obstruction was established including the age of onset, disease duration, vomiting, number of tumor marker elevation and CT combined variables (nomogram). The area under the curve was 0.982 (95% confidence interval: 0.959-1.000), and the calibration curve showed a good fit between the predicted probability and the actual probability. Conclusion    The differential diagnosis of cancerous and CD intestinal obstruction should be based on the combination of demography, history of present illness, tumor markers and imaging results. The predictive model of cancerous intestinal obstruction has certain diagnostic efficacy and needs further confirmation. 

Key words: intestinal obstruction, bowel cancer, Crohn’s disease, tumor marker, nomogram