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Objective:To investigate the diagnostic value of chest enhanced computed tomography (CT) for mediastinal lymph node metastasis of esophageal cancer and the influencing factors for its accuracy.Methods:The retrospective case-control study was conducted. The clinico- pathological data of 463 patients with esophageal cancer who underwent surgical treatment in the First Affiliated Hospital of Army Medical University from July 2016 to June 2021 were collected. There were 385 males and 78 females, aged (61±8)years. Observation indicators: (1) results of pre-operative chest enhanced CT and postoperative pathological examination; (2) diagnostic value of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer; (3) influencing factors analysis of the diagnostic accuracy of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer. Measurement data with normal distribution were represented as Mean± SD, and count data were represented as absolute numbers and (or) percentages. Sensitivity, specificity, positive predictive value, negative predictive value and Youden index were used for authenticity evaluation of diagnostic value of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer, and accuracy and Kappa value were used for reliability evaluation. The higher the value of above indicators, the higher the authenticity and (or) reliability. The univariate analysis was conducted using the chi-square test, and multivariate analysis was conducted using the binary Logistic regression model after including indicators with P<0.20 of univariate analysis. Results:(1) Results of preoperative chest enhanced CT and postoperative pathological examination. Of the 463 patients with esophageal cancer, mediastinal lymph node metastasis were diagnosed in 90 cases (including 35 cases of true positive and 55 cases of false positive) and no mediastinal lymph node metastasis were diagnosed in 373 cases (including 300 cases of true negative and 73 cases of false negative) by preoperative chest enhanced CT. Mediastinal lymph node metastasis were diagnosed in 108 cases and no mediastinal lymph node metastasis were diagnosed in 355 cases by postoperative patholo-gical examination. (2) Diagnostic value of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer. Authenticity evaluation of diagnostic value of chest enhanced CT for medias-tinal lymph node metastasis of esophageal cancer showed that sensitivity, specificity, positive predic-tive value, negative predictive value and Youden indexes were 32.41%(35/108), 84.51%(300/355), 38.89%(35/90), 80.43%(300/373), 0.169, respectively. Reliability evaluation showed that accuracy and Kappa value were 72.35%(335/463) and 0.180 ( P<0.05), respectively. (3) Influencing factors analysis of the diagnostic accuracy of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer. Results of univariate analysis showed that the tumor diameter and the depth of tumor invasion were related factors affecting the diagnostic accuracy of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer ( χ2=7.65, 6.07, P<0.05). Results of multi-variate analysis showed that the tumor diameter ≥2.1 cm was an independent risk factor affecting the diagnostic accuracy of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer ( odds ratio=2.05, 95% confidence interval as 1.23?3.43, P<0.05). Conclusions:The clinical value of chest enhanced CT for diagnosing mediastinal lymph node metastasis of esophageal cancer is limited, and the consistency with pathological results is quite different. The tumor diameter ≥2.1 cm is an independent risk factor affecting the diagnostic accuracy of chest enhanced CT for mediastinal lymph node metastasis of esophageal cancer
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Objective To explore the life quality of decompensated cirrhosis complicated with intestinal obstruction patients and analyze its influencing factors,and provide basis for clinical intervention.Methods In Affiliated People's Hospital of Hubei University of Medicine,a retrospective collection of 39 patients with decompensated cirrhosis complicated with intestinal obstruction from August 2018 to August 2019 were included in the observation group,including 25 males and 14 females,aged (52.34 ±2.64) years old,ranging from 39 to 64 years old.A total of 42 patients with decompensated cirrhosis not complicated with intestinal obstruction were selected as the control group by random number table method in simple random sampling,including 30 males and 12 females,aged (51.34 ± 3.45),ranging from 37 to 68 years old.The patients in the two groups were investigated by using the chronic liver disease patient quality of life scale-chronic liver disease questionnaire.The abdominal symptoms,fatigue,systemic symptoms,activity,emotion,anxiety,and the total score of quality of life of the patients in the two groups were compared,and the influencing factors were analyzed.Among them,measurement data of normal distribution were expressed as (Mean ± SD),and comparison between groups was evaluated by t test;Comparison of count data was evaluated by chi-square test.Factors affecting quality of life were analyzed by multiple linear regression.Results The scores of abdominal symptoms,fatigue,systemic symptoms,activity,emotion,anxiety and the total score of the observation group were (5.58 ± 1.79),(4.23 ± 1.74),(4.93 ± 1.39),(5.36 ± 1.36),(4.74 ± 1.05),(4.26 ± 1.25),(31.06 ± 6.53),respectively.The scores of the control group were(6.27 ± 1.12),(5.47 ± 1.26),(6.14 ± 0.78),(5.88 ± 0.93),(5.45 ± 0.82),(4.96 ± 0.94),(33.79 ± 4.01),respectively.The difference between the two groups was statistically significant (P ＜ 0.05).Multiple linear regression results showed that disease course,child-pugh classification of liver function,discomfort symptoms such as abdominal pain,abdominal distension and fatigue,nutrition status,gender,age,medical expenses payment method,family per capita monthly income and anxiety were influencing factors.Conclusions Decompensated cirrhosis complicated with intestinal obstruction patients life quality is lower than decompensated cirrhosis not complicated with intestinal obstruction patients,and the influencing factors include disease-related factors and non-disease-related factors.Medical staff should give patients corresponding intervention according to their conditions to improve the quality of life of patients as much as possible.
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Objective@#To explore the life quality of decompensated cirrhosis complicated with intestinal obstruction patients and analyze its influencing factors, and provide basis for clinical intervention.@*Methods@#In Affiliated People′s Hospital of Hubei University of Medicine, a retrospective collection of 39 patients with decompensated cirrhosis complicated with intestinal obstruction from August 2018 to August 2019 were included in the observation group, including 25 males and 14 females, aged (52.34±2.64) years old, ranging from 39 to 64 years old. A total of 42 patients with decompensated cirrhosis not complicated with intestinal obstruction were selected as the control group by random number table method in simple random sampling, including 30 males and 12 females, aged (51.34±3.45), ranging from 37 to 68 years old. The patients in the two groups were investigated by using the chronic liver disease patient quality of life scale- chronic liver disease questionnaire. The abdominal symptoms, fatigue, systemic symptoms, activity, emotion, anxiety, and the total score of quality of life of the patients in the two groups were compared, and the influencing factors were analyzed. Among them, measurement data of normal distribution were expressed as (Mean±SD), and comparison between groups was evaluated by t test; Comparison of count data was evaluated by chi- square test. Factors affecting quality of life were analyzed by multiple linear regression.@*Results@#The scores of abdominal symptoms, fatigue, systemic symptoms, activity, emotion, anxiety and the total score of the observation group were (5.58±1.79), (4.23±1.74), (4.93±1.39), (5.36±1.36), (4.74±1.05), (4.26±1.25), (31.06±6.53), respectively. The scores of the control group were(6.27±1.12), (5.47±1.26), (6.14±0.78), (5.88±0.93), (5.45±0.82), (4.96±0.94), (33.79±4.01), respectively. The difference between the two groups was statistically significant (P< 0.05). Multiple linear regression results showed that disease course, child-pugh classification of liver function, discomfort symptoms such as abdominal pain, abdominal distension and fatigue, nutrition status, gender, age, medical expenses payment method, family per capita monthly income and anxiety were influencing factors.@*Conclusions@#Decompensated cirrhosis complicated with intestinal obstruction patients life quality is lower than decompensated cirrhosis not complicated with intestinal obstruction patients, and the influencing factors include disease-related factors and non-disease-related factors. Medical staff should give patients corresponding intervention according to their conditions to improve the quality of life of patients as much as possible.
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Objective·To analyze the clinical characteristics of decompensated cirrhosis patients with intestinal obstruction and related risk factors.Methods·Clinical data of 1 783 decompensated cirrhosis patients treated between March 2010 and March 2016 were collected.Of them,128 (7.18％) patients with intestinal obstruction were screened as the observation group and 128 patients without intestinal obstruction were randomly selected as the control group.Clinical data of two groups were retrospectively investigated,clinical characteristics were compared and analyzed,and related risk factors were analyzed with the Logistic regression analysis.Results·The clinical symptoms of decompensated cirrhosis patients with intestinal obstruction were hidden and misdiagnoses or delayed diagnoses were common.The incidences of abdominal pain,abdominal distension,vomiting,stop exhaust defecate,ascites,electrolyte disorders,fever,and spontaneous peritonitis were significantly higher in the observation group than in the control group (P ＜ 0.05).The results of univariate analysis showed that age,history of abdominal surgery,white blood cell count,serum sodium,serum potassium,neutrophil percentage,and serum albumin were risk factors for decompensated cirrhosis patients with intestinal obstruction.The results of multivariate analysis indicated that age,history of abdominal surgery,white blood cell count,serum sodium,serum potassium,neutrophil percentage,and serum albumin were independent risk factors for decompensated cirrhosis patients with intestinal obstruction.Conclusion·Decompensated cirrhosis patients with age ≥ 50 years old,a history of abdominal surgery,the abdominal cavity infection,low potassium,hyponatremia,and lower serum albumin are likely to develop the intestinal obstruction.