Sie können Operatoren mit Ihrer Suchanfrage kombinieren, um diese noch präziser einzugrenzen. Klicken Sie auf den Suchoperator, um eine Erklärung seiner Funktionsweise anzuzeigen.
Findet Dokumente, in denen beide Begriffe in beliebiger Reihenfolge innerhalb von maximal n Worten zueinander stehen. Empfehlung: Wählen Sie zwischen 15 und 30 als maximale Wortanzahl (z.B. NEAR(hybrid, antrieb, 20)).
Findet Dokumente, in denen der Begriff in Wortvarianten vorkommt, wobei diese VOR, HINTER oder VOR und HINTER dem Suchbegriff anschließen können (z.B., leichtbau*, *leichtbau, *leichtbau*).
Inguinal incarcerated hernia is a common disease in hernia surgery. This study was conducted to collect risk factors for strangulated inguinal hernia and to construct a predictive model to assist surgeons in decision-making.
Methods
We conducted a retrospective analysis of the clinical data from patients diagnosed with incarcerated inguinal hernias in the Department of Gastrointestinal Surgery, Huai’an Hospital Affiliated to Xuzhou Medical University, from January 2020 to January 2023. The independent risk factors for the progression of incarcerated inguinal hernias to strangulation were screened in the modeling group using univariate and logistic regression analyses and were used for construction of the nomogram prediction model.
Results
Tenderness in the inguinal region (OR = 9.164, 95% CI = 2.540 ~ 33.066), intestinal obstruction (OR = 6.781, 95% CI = 1.568 ~ 29.330), elevated CRP (OR = 1.023, 95% CI = 1.009 ~ 1.037), and elevated neutrophils (OR = 1.253, 95% CI = 1.073 ~ 1.463) were identified as independent risk factors for the progression of incarcerated inguinal hernias to strangulation, while elevated prealbumin (OR = 0.992, 95% CI = 0.986 ~ 0.998) was identified as an independent protective factor. A risk prediction model for the progression of incarcerated inguinal hernias to strangulation was constructed based on these five observational indicators. The model’s discrimination was tested by the ROC curve and showed AUC = 0.906, 95% CI = 0.851 ~ 0.962, and P < 0.05. The calibration curve showed good agreement with the ideal curve. The clinical decision curves showed that the model had good clinical utility.
Conclusion
Tenderness in the inguinal region, combined intestinal obstruction, elevated CRP, and elevated neutrophils are independent risk factors for strangulation in incarcerated inguinal hernias, while elevated prealbumin is an independent protective factor. The constructed nomogram prediction model exhibits high sensitivity, specificity, and clinical utility.
Ning Chen, Mengjie Lv, and Ying Chen are co-first authors of this article.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Introduction
An incarcerated inguinal hernia is a common general surgical emergency in which the contents of the abdominal cavity, such as the greater omentum, small bowel intestines, and large bowel intestines, protrude toward the body surface through a defect in the inguinal region, and the hernia contents cannot be returned.The etiology of incarcerated inguinal hernias is associated with factors including sex, age, and family history. Furthermore, certain studies have indicated that a history of chronic smoking and prior lower abdominal surgeries may elevate the incidence of this condition [1‐4]. Patients with inguinal incarcerated hernia who are older, with more comorbid underlying diseases, and with high surgical risk can try manipulative reset, and those who can’t be reset should undergo emergency surgery to prevent complications such as intestinal obstruction, intestinal perforation, and intestinal necrosis [5, 6]. Inguinal hernia occurs in the elderly, the elderly for the pain is not sensitive, when the patient really feel the pain in the inguinal area, often at this time the intestinal tube has already begun to have intestinal ischemia manifestation, some studies have shown that the elderly patients with inguinal hernia emergency surgery complication rate and mortality rate is higher, incarcerated inguinal hernia emergency surgery increased the risk of death after 5–15 times [7]. Thus, we need to determine whether the embedded intestinal tube is strangulated as soon as possible, and carry out surgical intervention in time to avoid serious complications. In this study, we retrospectively analyzed the clinical data and laboratory indexes of patients with inguinal incarcerated hernia, analyzed the risk factors of inguinal incarcerated hernia progressing to intestinal strangulation, and constructed a risk prediction model for the occurrence of strangulation in inguinal incarcerated hernia, in order to help the surgeons make a better clinical judgment.
Materials and methods
Study subjects
This study was approved by Ethics Committee of Affiliated Huai’an Hospital of Xuzhou Medical University, Ethics No. HEYLL201978, to retrospectively analyze the clinical data of patients who underwent emergency surgery for “incarcerated inguinal hernia” at the Department of Gastrointestinal Surgery, Huai’an Hospital, Xuzhou Medical University, from January 2020 to January 2023 in our hospital. Inclusion criteria: (1) according to the 2018 edition of “International Management Guidelines for Inguinal Hernia” [8], incarcerated inguinal hernia was defined as an irreducible hernia with localized tenderness, absence of cough impulse, irreducible inguinal mass, and radiographic evidence of bowel obstruction (if applicable). The specific diagnostic criteria are shown in Table 1.Diagnosis required consensus between two senior surgeons. We acknowledge the subjectivity in clinical signs (e.g., tenderness assessment); (2) hernia content is small intestine; (3) patient’s age ≥ 18 years old; (4) patients signed an informed consent form before the operation, agreeing to the use of relevant data for clinical research.
Table 1
Detailed diagnostic criteria for incarcerated inguinal hernia
Physical Examination or CT signs
Operation Specification or Definition
Clinical criteria
(Must meet 2 or more requirements)
Irreducible inguinal mass
The patient was placed in the supine position, and the examiner still could not return the hernia sac after holding it for ≥ 1 min
Localized tenderness
Tenderness in projection area of hernia sac
Absence of cough impulse
The examiner’s fingers did not feel impact when the patient coughed
Hernia sac neck stenosis with distal intestinal swelling
Anzeige
Exclusion criteria: (1) elective surgery and those who refused surgical treatment; (2) hernia content is large omentum and other non-intestinal tissues; (3) combined with acute appendicitis; (4) combined with hematologic diseases; (5) abdominal malignant tumors were found during the operation; (6) psychiatric illnesses can not get cooperation; (7) preoperative thrombosis; (8) imperfect clinical data. The final inclusion of 120 patients, including 84 male patients (average 64.7 ± 19.4 years old), female patients 36 (average 67.8 ± 17.4 years old), embedded intestinal tube strangulation necrosis, intraoperative necrotic small bowel resection was performed in 45 cases, of which 38 cases of open surgery, 5 cases of laparoscopic surgery, laparoscopic conversion to open surgery in 2 cases, the small intestine was dragged back to the abdominal cavity, and the intestinal blood flow There were 75 cases in which the color was restored to normal and no bowel resection was performed, including 66 cases of open surgery and 9 cases of laparoscopic surgery.
Observation indicators
(1) Baseline Characteristics: Age, gender. (2) Clinical Symptoms: Presence or absence of inguinal tenderness, duration of incarceration, history of abdominal surgery, presence or absence of intestinal obstruction, type of inguinal hernia. (3) Laboratory Indicators: White blood cell count, neutrophil count, CRP, prothrombin time, fibrinogen, D-dimer, cholinesterase, prealbumin, and other indicators.
Statistical analysis
Statistical analysis was performed using SPSS 26.0 software. Categorical data were analyzed using the χ2 test or Fisher’s exact probability test, and data were expressed as percentages. Continuous variables were assessed for normality using the Shapiro-Wilk test. Normally distributed data were analyzed using the independent samples t-test and expressed as x̄ ± s; non-normally distributed data were analyzed using the Mann-Whitney U test and expressed as median (interquartile range). Statistically significant observational indicators were incorporated into a multivariate binary logistic regression analysis using a stepwise regression method, based on the study’s objectives. A nomogram was Generated for the statistically significant indicators from the multivariate logistic regression using R 4.1.2 software. The model was evaluated using R software. The model’s discrimination was assessed by generating a receiver operating characteristic (ROC) curve, and the calibration of the model was assessed by generating a calibration plot. A decision curve was generated to evaluate the clinical utility of the model.
Results
Analysis of Influencing Factors. Differential analysis revealed statistically significant differences between the groups in clinical symptoms, including the presence or absence of inguinal tenderness, intestinal obstruction, and incarceration duration. Laboratory indicators, including white blood cell count, neutrophil count, CRP, fibrinogen, D-dimer, cholinesterase, and prealbumin, also showed statistically significant differences between the two groups, as presented in Table 2. Multivariate logistic regression analysis (stepwise regression method) was performed on the statistically significant indicators from the differential analysis. The results indicated that the presence or absence of inguinal tenderness, intestinal obstruction, CRP, and neutrophil count were independent risk factors for the progression of incarcerated inguinal hernia to strangulation. Prealbumin was identified as an independent protective factor. These findings are detailed in Table 3. ROC curve analysis determined the cutoff values for neutrophils (7.49), CRP (11.40), and prealbumin (275.20).
Table 2
Single factor analysis of the progression of incarcerated hernia to strangulation
Variables
Gender
Inguinal Tenderness
Intestinal Obstruction
Abdominal Surgery History
Female
Male
None
Present
None
Present
None
Present
Category
Non-Strangulated (n=75)
18 (24.0)
57 (76.0)
38 (50.7)
37 (49.3)
69 (92.0)
6 (8.0)
72 (96.0)
3 (4.0)
Strangulated (n=45)
18 (40.0)
27 (60.0)
8 (17.8)
37 (82.2)
30 (66.7)
15 (33.3)
41 (91.1)
4 (8.9)
χ²
3.429
12.87
12.502
1.224
p
0.064
0.001**
0.000**
0.269
Variables
Hernia Location
Hernia Type
Left
Right
Bilateral
Indirect
Femoral
Direct
Combined
Category
Non-Strangulated (n=75)
27 (36.0)
41 (54.7)
7 (9.3)
52 (69.3)
16 (21.3)
4 (5.3)
3 (4.0)
Strangulated (n=45)
13 (28.9)
27 (60.0)
5 (11.1)
27 (60.0)
17 (37.8)
0
1 (2.2)
χ²
0.657
5.804
p
0.72
0.122
Observation Indicator
Age (years)
Incarceration Duration (d)
WBC (´103/mm3)
Neutrophils (´103/mm3)
CRP (mg/L)
Category
Non-Strangulated (n=75)
71.00 (55.00,80.00)
0.42 (0.13,1.00)
8.26 (6.69,10.68)
6.58 (4.46,8.59)
5.00 (3.20,17.90)
Strangulated (n=45)
72.00 (58.00,80.00)
1.00 (0.30,4.00)
9.93 (7.95,12.90)
8.32 (6.65,11.36)
44.70 (25.95,82.25)
z/t
−0.388
−2.695
−2.461
−3.483
−6.006
p
0.698
0.007**
0.014*
0.000**
0.000**
Observation Indicator
PT (s)
Fibrinogen (g/L)
D-Dimer (mg/L)
Cholinesterase (U/L)
Prealbumin (mg/L)
Category
Non-Strangulated (n=75)
12.40 (11.90,13.10)
2.56 (2.11,3.38)
0.69 (0.20,1.36)
7082.52±1928.09
242.32±87.68
Strangulated (n=45)
12.60 (11.75,13.50)
2.76 (2.56,4.18)
1.28 (0.98,2.07)
5879.13±2548.33
177.76±102.57
z/t
−0.521
−2.204
−3.705
2.733
3.661
p
0.602
0.028*
0.000**
0.008**
0.000**
**Note: * represents P < 0.05, ** represents P < 0.01**
Table 3
Multivariate logistic regression of incarcerated hernia progressing to strangulation
Observation Indicator
Regression Coefficient
Standard Error
Wald χ²
p-value
OR
95% CI for OR
Inguinal Tenderness
2.215
0.655
11.448
0.001
9.164
2.540 - 33.066
Intestinal Obstruction
1.914
0.747
6.561
0.010
6.781
1.568 - 29.330
Neutrophils (×10³/mm³)
0.225
0.079
8.127
0.004
1.253
1.073 - 1.463
CRP (mg/L)
0.023
0.007
10.522
0.001
1.023
1.009 - 1.037
Prealbumin (mg/L)
-0.008
0.003
7.602
0.006
0.992
0.986 - 0.998
Intercept
-3.176
1.036
9.400
0.002
0.042
0.005 - 0.318
Anzeige
A predictive model for the progression of incarcerated hernia to strangulation is presented. The nomogram of this model is shown in Fig. 1. Various clinical data from a patient with an incarcerated inguinal hernia were collected, corresponding to the five indicators in the model. The operation definitions of all variables in the model are shown in the Table 4. Each indicator yields a corresponding score. The total score of the five observed indicators is calculated, and a vertical line is drawn downwards to determine the risk probability of incarcerated inguinal hernia progressing to strangulation. The final binary logistic regression model equation is P = 1/(1 + e(−3.176 + 2.215*presence or absence of inguinal tenderness + 1.914*presence or absence of intestinal obstruction + 0.225*neutrophil count + 0.023*CRP-0.008*prealbumin)), where P represents the probability of incarcerated hernia progressing to strangulation. The ROC curve was plotted using R software, yielding an AUC of 0.906 (P < 0.05, 95% CI: 0.851–0.962), with a sensitivity of 91.11% and a specificity of 82.67%. This indicates that the model has excellent discriminatory ability for predicting the progression of incarcerated inguinal hernia to strangulation, as shown in Fig. 2. The calibration curve was plotted using R software, as shown in Fig. 3. The diagonal line in the figure represents the ideal prediction, and the solid line represents the predictive ability of the model. The better the fit between the two, the smaller the gap between the predicted and actual outcome events of the model. The figure shows that the gap between the predicted and actual outcome events of the model is minimal. The DCA curve was plotted using R software, as shown in Fig. 4. The All Line represents that all patients will progress to strangulation, and the None Line represents that no patients will progress to strangulation. The optimal cutoff value of the model in ROC analysis is 76.8%. Below this threshold (dashed line), the decision curve of the model is located above the None line and the All line, indicating that the model has clinical utility.
Fig. 1
Nomogram risk model for predicting strangulation in inguinal incarcerated hernia
Surgical intervention is the definitive treatment for incarcerated inguinal hernias. Current research has primarily focused on identifying risk factors associated with ischemia and strangulation in incarcerated inguinal hernias. However, these studies have not yet employed statistical modeling to comprehensively assess an individual patient’s risk of strangulation. This study aims to retrospectively analyze clinical data and develop a risk prediction model using rigorous statistical methods. The objective is to identify risk and protective factors for strangulation in incarcerated inguinal hernias, thereby enabling clinicians to make timely surgical decisions and improve patient outcomes.
Zhou [9] et al. posited that tenderness in the inguinal region is an independent risk factor for the progression of incarcerated inguinal hernias to strangulation, with an OR of 3.15. In this study, the presence or absence of inguinal tenderness was identified as an independent risk factor for strangulation in incarcerated inguinal hernias, with an OR of 9.164, indicating that patients with inguinal tenderness had a 9.164-fold increased risk of strangulation compared to those without tenderness. Prolonged incarceration of the bowel can lead to increased tension, which, upon physical examination by the physician, can elicit pain in the patient, and potentially lead to erythema and swelling in the inguinal region. Given the prevalence of this condition in the elderly, who may exhibit diminished pain perception [10], meticulous physical examination is crucial. Concomitant observation of the patient’s facial expressions, demeanor, and movements during the examination is recommended to avoid delays in diagnosis and intervention.
Studies by Chinese scholars, including Zheng et al.[11, have identified concomitant intestinal obstruction as an independent risk factor for the progression of incarcerated inguinal hernias to strangulation, with an odds ratio (OR) of 5.600. Xie’s research [12] demonstrated that among 36 patients undergoing bowel resection for inguinal hernia, 31 exhibited signs of intestinal obstruction, with an OR of 4.982 in regression analysis for the presence of intestinal obstruction. In this study, the OR for the presence of intestinal obstruction was 6.781. Therefore, when patients with incarcerated inguinal hernias present with abdominal pain, distension, and cessation of flatus and bowel movements, the possibility of intestinal ischemia should be considered, necessitating immediate surgical intervention. Furthermore, in this study, a neutrophil count > 7.49 (103/mm3) was identified as an independent risk factor for the progression of incarcerated inguinal hernias to strangulation, with an OR of 1.253, indicating the significance of this inflammatory marker in the assessment of these patients. A meta-analysis [13] revealed a mean difference (MD) of 2.2 in neutrophil counts between the bowel resection group and the non-resection group, which is consistent with our findings, suggesting the importance of monitoring these values in the management of such patients.
Wu et al. [14], in their analysis of clinical data from 83 patients with incarcerated inguinal hernias, found a statistically significant difference in C-reactive protein (CRP) levels between the strangulation and non-strangulation groups (P = 0.032). Regression analysis yielded an odds ratio (OR) of 1.260, although the P-value was 0.672, which was not statistically significant (P > 0.05), potentially due to the limited sample size. Gao et al. [15] suggested that CRP could serve as a specific marker for early small bowel necrosis, while Wu et al. [16] reported a highly significant difference in CRP levels between simple small bowel obstruction and strangulated intestinal obstruction. The present study’s findings indicate that CRP levels > 11.40 mg/L are an independent risk factor for the progression of incarcerated inguinal hernias to strangulation, with an OR of 1.023 and a statistically significant P-value of 0.001 (P < 0.05). Therefore, in patients with incarcerated inguinal hernias, elevated CRP levels should raise suspicion for potential intestinal strangulation and necrosis. Intraoperative exploration of the abdominal cavity is warranted to avoid overlooking this complication. It is undeniable that CRP and neutrophils are non-specific inflammatory indicators, which also increase in some common infectious diseases, such as cholecystitis, appendicitis, pneumonia, etc. The model achieved recalibration of these non-specific indicators by combining them with specific clinical signs such as groin tenderness and intestinal obstruction. However, some common infectious diseases must be excluded before using the model, so as to improve the accuracy of the model. The size of CRP, neutrophils and other laboratory markers is not related to the severity of the disease. We need to pay attention to the dynamic changes in laboratory markers and comprehensively judge the patient’s risk level based on their physical examination, imaging findings, and other factors.
Anzeige
While some studies suggest that incarceration duration exceeding 24–48 h is an independent risk factor for the progression of incarcerated inguinal hernias to strangulation [11, 17, 18], this remains controversial. Research by Wu et al. [14] did not identify incarceration duration as an independent risk factor for strangulation of the hernia contents. In the present study, differential analysis between the two groups indicated a longer incarceration duration in the strangulation group compared to the non-strangulation group, with statistical significance (P = 0.007). However, incarceration duration did not enter the regression model, indicating that it was not an independent risk factor for strangulation of the hernia contents. This aligns with the findings of Wu et al. [14]. The discrepancy may be attributed to a small sample size and selection bias. Due to the retrospective nature of this study, the collected incarceration time may not be the actual time when patients began to experience incarceration. Some elderly or cognitively impaired patients may not be able to tell the emergency doctor the exact time of the entrapment. In future prospective studies, pressure monitoring devices will be used to monitor the pressure of the hernia sac, and the time when the pressure reaches the set value is the time when entrapment begins. Collect the time from entrapment to strangulation of patients and include it in KM survival analysis. Through analysis and comparison, we can understand how long it is expected for patients to go from entrapment to strangulation. With this time, we can allocate medical resources more reasonably. Patients in the high-risk group have been allocated more medical resources, while patients in the low-risk group can have follow-up appointments at regular intervals. With this time, surgeons can better handle emergency patients of this kind.
In this study, we observed a notable indicator, prealbumin. The levels of prealbumin were 242.315 ± 87.683 mg/L in the non-strangulated group and 177.760 ± 102.574 mg/L in the strangulated group, demonstrating a statistically significant difference (P = 0.000). Multivariate regression analysis revealed that prealbumin served as an independent protective factor against the progression of inguinal incarcerated hernia to strangulation, with an odds ratio (OR) of 0.992. A literature review did not identify any prior studies reporting these findings. Research [19, 20] indicates that when the body is subjected to external stressors such as surgery, infection, or trauma, the liver shifts from synthesizing structural plasma proteins to synthesizing acute-phase proteins. These acute-phase proteins facilitate the clearance of toxic metabolites generated during infection or trauma. Consequently, prealbumin levels decrease significantly in the presence of severe infection, which aligns with the progression from incarcerated to strangulated bowel. All laboratory markers have a certain degree of non specificity, and we need to pay more attention to the trend of marker changes. We cannot solely rely on a high value to determine that the patient’s current situation is very dangerous. This is one-sided. We need to dynamically analyze the trend of laboratory marker changes and make comprehensive judgments based on other risk indicators.
Another key finding of this study was the development of a nomogram prediction model for strangulation in incarcerated inguinal hernias. This model, derived from a binary logistic regression equation P = 1/(1 + e(−3.176 + 2.215*presence or absence of inguinal tenderness + 1.914*presence or absence of intestinal obstruction + 0.225*neutrophil count + 0.023*CRP-0.008*prealbumin)), calculates the probability of strangulation. The model demonstrated a high AUC of 0.906 on ROC curve analysis, with a sensitivity of 91.11% and specificity of 82.67%, indicating robust predictive capability. The sample size of this study is 120 cases. In order to prevent overfitting and Generalization, we have added overfitting analysis, proposed risk management for overtreatment, and will increase external validation in future studies to improve Generalization ability. After 1000 bootstrap corrections on the model, the predicted probability shrinkage coefficient is 0.92 (close to 1.0 indicates a low risk of overfitting). After adding 20% random noise, the AUC only decreased by 0.02, confirming its stability. When patients with incarcerated inguinal hernia use predictive models to obtain specific risk values, in order to further control clinical risks and avoid unnecessary emergency surgeries, i.e. false positives, we set up mandatory imaging examinations. When the predictive model we established calculated that the risk of strangulation of incarcerated inguinal hernia in the current patient was ≥ 0.7, the specificity of the model was 82.67%, and surgery was recommended, but attention should be paid to avoiding the abuse of critical values. When the predictive model we established calculates a risk of 0.3–0.7 for incarcerated inguinal hernia strangulation in the current patient, we must further improve abdominal enhanced CT. Through CT examination, we can prevent excessive surgery. In future research, we will perform spatial validation on the prediction model by using data from different research centers in the same country (such as research centers in different provinces) or data from different countries to validate the model and evaluate its generalization ability. Our model’s performance (AUC = 0.906) requires external validation in larger cohorts to mitigate overfitting risks. Premature adoption could lead to overtreatment; thus, we strongly recommend further validation.
This study is a retrospective study, in which all patients underwent surgery immediately after admission. There was no research on whether delaying surgery in low-risk patients had an impact on intestinal resection rate and mortality. A prospective cohort study will be conducted in the future to investigate the safety of delaying surgery. The predictive model integrates CRP and neutrophils, and even if a clear hernia sac cannot be reached and the patient experiences intestinal ischemia, this model still has a certain predictive ability. For atypical inguinal incarcerated hernia patients (obese, unable to reach obvious hernia sac) or elderly patients with cognitive impairment, if the predictive model indicates high risk, it must be combined with imaging examination to exclude strangulated hernia. Whether the model can predict intestinal ischemia needs further external validation in an unspecified abdominal pain cohort to draw conclusions. Before further prospective experiments are conducted to validate this model, we cannot directly use predictive models to guide clinical doctors on whether to perform surgery. Predictive models are more based on the comprehensive analysis of some high-risk factors of patients to tell us that they have a greater probability of strangulation. We need to be vigilant and take timely intervention measures to prevent adverse events from occurring.Furthermore, decision curve analysis (DCA) revealed the model’s clinical utility. Future prospective, single-center or multi-center clinical trials will be conducted to validate the accuracy, specificity, and sensitivity of this model, providing further theoretical and practical support for the management of incarcerated inguinal hernias. We are initiating a multicenter prospective trial (N = 300) to validate the model. Future iterations will combine radiological features such as CT ischemic signs to further improve the accuracy of predictive models.
Anzeige
Future research directions
In future research, we will focus on external validation of the model, followed by model upgrades and clinical translation. In the external validation of the model, we divide it into two stages. In the first stage, prospective cohort studies can be conducted to validate the identification, calibration, and clinical benefits of the model, and multiple centers can be selected domestically or internationally for validation. In the second stage, a randomized controlled study was conducted to validate the clinical efficacy of the predictive model. For example, patients with incarcerated hernia can be randomly divided into two groups: the conventional treatment group and the model guided treatment group. The effectiveness of the model can be verified by comparing the intestinal resection rate and medical expenses between two groups of patients. Conduct subgroup studies in the model treatment group, dividing low-risk patients into two groups: one group with delayed surgery and the other group with immediate surgery. Compare the intestinal resection rates of the two groups of patients, analyze whether delayed surgery has an impact on intestinal resection rates, and further study the safe time of delayed surgery. In the later stage, the model will be further enriched and calibrated by incorporating radiomics indicators, and the research results will be translated into clinical applications, making the study more meaningful. The predictive model is not just a simple mathematical equation, but an intelligent auxiliary tool that has sparked a new revolution in the diagnosis and treatment of hernia emergencies!
Conclusion
Tenderness in the inguinal region, combined intestinal obstruction, elevated CRP, and elevated neutrophils are independent risk factors for strangulation in incarcerated inguinal hernias, while prealbumin is an independent protective factor. The constructed nomogram prediction model exhibits high sensitivity, specificity, and clinical utility.
Acknowledgements
We thank all subjects for their support and understanding of this study and all the participants for their wonderful cooperation.
Data statement All original data are available upon reasonable request to the corresponding authors.
Anzeige
Declarations
Conflict of interest
The authors declare that they have NO affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.
Conflict of interest
The authors declare no conflicts of interest.
Ethical approval
Approved by the Ethics Committee of Affiliated Huai’an Hospital of Xuzhou Medical University (Ethics No. HEYLL201978).
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Unsere Produktempfehlungen
Die Chirurgie + umfangreiches Online-Angebot
Print-Titel
Das Abo mit mehr Tiefe
Mit der Zeitschrift Die Chirurgie erhalten Sie zusätzlich Online-Zugriff auf weitere 43 chirurgische Fachzeitschriften, CME-Fortbildungen, Webinare, Vorbereitungskursen zur Facharztprüfung und die digitale Enzyklopädie e.Medpedia.
Mit e.Med Chirurgie erhalten Sie Zugang zu CME-Fortbildungen des Fachgebietes Chirurgie, den Premium-Inhalten der chirurgischen Fachzeitschriften, inklusive einer gedruckten chirurgischen Zeitschrift Ihrer Wahl.
Bouassida M, Dougaz MW, Beji H, Guermazi H, Zribi S, Kammoun N, Bouasker I, Mongi Mighri M, Nouira R, Touinsi H (2022) Intestinal ischemia in patients with incarcerated groin hernia: proposal and validation of a score. Langenbecks Arch Surg 407(6):2547–2554. https://doi.org/10.1007/s00423-022-02521-9CrossRefPubMedPubMedCentral
2.
Köksal H, Ateş D, Nazik EE, Küçükosmanoğlu İ, Doğan SM, Doğru O(2018) Predictive value of preoperative neutrophil-to-lymphocyte ratio while detecting bowel resection in hernia with intestinal incarceration .Ulus Travma Acil Cerrahi Derg 24(3) : 207–210. https://doi.org/10.5505/tjtes.2017.93937
3.
Li H, Wang JJ, Zhang M, Ren B, Li JX, Xu L, Wu H(2020) Prognostic significance of systemic immune-inflammation index in patients with intrahepatic cholangiocarcinoma undergoing hepatic resection.World J Gastrointest Oncol 12(4) : 467–482. https://doi.org/10.4251/wjgo.v12.i4.467
Zhou HH(2017) Study on Factors that would Trigger the Progression of Incarcerated Inguinal Hernia into Strangulated Inguinal Hernia. Wenzhou; Wenzhou Medical University.
10.
Ge BJ, Huang Q, Liu LM, Bian HP, Fan YZ (2010) Risk factors for bowel resection and outcome in patients with incarcerated groin hernias.Hernia 14: 259–264. https://doi.org/10.1007/s10029-009-0602-2
11.
Zhou H, Ruan X, Shao X, Huang X, Fang G, Zheng X. Clinical value of the neutrophil/lymphocyte ratio in diagnosing adult strangulated inguinal hernia.International Journal of Surgery 36: 76–80. https://doi.org/10.1016/j.ijsu.2016.10.026
12.
Xie X, Feng S, Tang Z, Chen L, Huang Y, Yang X(2017) Neutrophil-to-lymphocyte ratio predicts the severity of incarcerated groin hernia.Medical Science Monitor: International Medical Journal of Experimental and Clinical Research 23: 5558. https://doi.org/10.12659/msm.905728
13.
Chen P, Huang L, Yang W, He D, Liu X, Wang Y, Yu Y, Yang L, Zhou Z(2020)Risk factors for bowel resection among patients with incarcerated groin hernias: a meta-analysis.The American Journal of Emergency Medicine 38(2) : 376–383. https://doi.org/10.1016/j.ajem.2019.09.023
14.
Wu H,Ye ZY,Gao GD,Zhang FJ,Huang YG (2020) Analysis of influencing factors on strangulation of contents in incarcerated inguinal hernia .Prev Med 32(12) : 1257–1259.(in Chinese). https://doi.org/10.19485/j.cnki.issn2096-5087.2020.12.017
15.
Gao QJ,Liu RH,Wei QZ,Wang l (2017) Serum creatine kinase,analysis in early diagnosis of strangulated intestinal obstruction in the determination of C-reactive protein and D-dimer level two.Chin J Lab Diagn 21(7) : 1178–1181.(in Chinese). https://doi.org/10.3969/j.issn.1007-4287.2017.07.028
16.
Wu DH,Liang YP,Yang XL,Lin XH,Zheng MY (2009)The value of determining serum c-reactive protein parameters in the early diagnosis of strangulated intestinal obstruction.Med Innov Chin 6(28) : 7–8.(in Chinese). https://doi.org/10.3969/j.issn.1674-4985.2009.28.004
17.
Wu LL,Zhou JP,Shi J,Ju F,Xu X(2017) Multivariate analysis of the risk of intestinal resection during surgery in patients with incarcerated femoral hernia.Hainan Med J 28(23) : 3923–3924.(in Chinese). https://doi.org/10.3969/j.issn.1003-6350.2017.23.046
18.
Li ZW,Zhang YX,Wang l,li ZF,Luo XM (2020) Analysis of factors of intestinal necrosis in adult incarcerated inguinal hernia.Chin J Heria Abdominal Wall Surg(Electronic Edition) 14(04) : 433–437.(in Chinese). https://doi.org/10.3877/cma.j.issn.1674-392X.2020.04.028
19.
Zu SY,Wang S,Yang FL,Chen BG,Ma MZ(2016)Changes in serum prealbumin levels in patients with acute myocardial infarction and their relationship with the severity of the disease. J Clinic Med Pract 20(05) : 163–164.(in Chinese). https://doi.org/10.7619/jcmp.201605058
20.
Wang YX,Wu BH,Li GQ(2022) Evaluation value of prostaglandin-2, high mobility group box protein B1 and prealbumin on disease progression and prognosis in pa-tients with sepsis. J Clinic Exper Med 21(11) : 1159–1162.(in Chinese). https://doi.org/10.3969/j.issn.1671-4695.2022.11.011
Ist eine Speichelgangsblockade und die damit verbundene Sialadenitis nicht durch Steine bedingt, wird oftmals versucht, die Symptomatik zu lindern, indem man den Gang mechanisch weitet. Ein aktuelles Review kann den Eingriff als chancenreiches Verfahren bestätigen und deckt gleichzeitig Schwächen auf.
Mehr als eine Million Menschen in Deutschland leiden unter Hallux valgus – eine Fehlstellung des Großzehs, die je nach Schweregrad und Symptomen behandelt wird. Welche neuen Empfehlungen die aktualisierte S2e-Leitlinie bietet, erklärt der Orthopäde Prof. Sebastian Baumbach im MedTalk Leitlinie KOMPAKT der Zeitschrift Orthopädie und Unfallchirurgie.
Ein chirurgischer Eingriff kann für Patienten mit primärem Hyperparathyreoidismus gegenüber dem konservativen Management metabolisch von Vorteil sein. Denn wie eine Studie zeigt, senkt die Operation das Diabetesrisiko.
