Tomita评分及改良Tokuhashi评分对脊柱转移瘤手术患者生存期预测的准确性

目的:分析Tomita评分及改良Tokuhashi评分对脊柱转移瘤手术患者生存期预测的准确性。方法:回顾性分析我院2010年3月～2019年7月因脊柱转移瘤行初次手术治疗患者的临床资料,纳入末次随访前已去世或随访时间≥12个月的患者。通过Kaplan-Meier生存分析和log-rank检验,分析患者整体样本及常见的五种病理类型(肺癌、肾癌、乳腺癌、甲状腺癌、前列腺癌)脊柱转移瘤的生存时间,比较Tomita评分及改良Tokuhashi评分不同分组间差异。并通过比较患者的实际生存时间与Tomita评分及改良Tokuhashi评分预测的生存时间来判断这两种评分在不同分组及上述五种病理类型脊柱转移瘤中的预测准确性。结果:共221例患者纳入本研究,末次随访时94例(42.5%)存活,存活患者的中位随访时间为24个月(12～108个月)。纳入患者的中位生存时间为27.0个月(95%CI:22.1～31.9个月),1年生存率为67.4%。Tomita评分2～3分、4～5分、6～7分和8～10分患者的中位生存时间分别为34.0个月(95%CI:22.3～45.7个月)、41.0个月(95%CI:19.1～62.9个月)、16.0个月(95%CI:5.2～26.8个月)和12.0个月(95%CI:2.1～21.9个月)(P0.001)。改良Tokuhashi评分0～8分、9～11分和12～15分患者的中位生存时间分别为18.0个月(95%CI:11.6～24.4个月)、30.0个月(95%CI:16.2～43.8个月)和51.0个月(95%CI:33.2～68.8个月)(P0.001)。在所有患者中,Tomita评分可准确预测30.2%(57/189)患者的生存时间,改良Tokuhashi评分可准确预测32.6%(72/221)患者的生存时间。仅Tomita评分2～3分和改良Tokuhashi评分12～15分的预测准确性大于50%。在五种常见的病理类型中,Tomita评分对乳腺癌脊柱转移瘤、改良Tokuhashi评分对甲状腺癌脊柱转移瘤的预测准确性相对较好,分别为43.5%和56.3%;二者对肺癌脊柱转移瘤的预测准确性最差,Tomita评分和改良Tokuhashi评分对其预测准确性分别为22.2%和26.3%。结论:Tomita评分及改良Tokuhashi评分在整体上仍可以较好地区分不同生存时间等级的患者,但是不同等级患者的实际生存时间均比预测长。其对个体预测准确性仍不满意,尤其是对肺癌脊柱转移瘤的患者。     

新型胸腰椎骨折损伤AO分型系统的可信度和可重复性研究

目的:评价新型胸腰椎骨折损伤AO分型系统的可信度和可重复性,探讨影响分型一致性的主要原因。方法:选取5名医师,根据术前正侧位X线片、CT、MRI影像,用新型AO分型系统独立对收治的70例胸腰椎骨折损伤患者进行分型。对同一例患者,5名医师在一次分型中只要有1名医师分型不同即认定为不一致。6周后,打乱资料顺序再次分型。全部资料均不含与分型有关的任何标记,应用加权Cohen′s Kappa系数(unweighted Cohen Kappa coefficients)评价观察者间可信度和观察者内可重复性。结果:新型AO分型系统的可信度Kappa系数为0.602,可重复性平均Kappa系数为0.782。在3大骨折类型中,压缩型(A型)和分离移位型(C型)损伤的判定具有中、高度的可信度和极好的可重复性,可信度Kappa系数分别为0.604、0.662,可重复性平均Kappa系数分别为0.787、0.761;牵张型损伤(B型)判定的一致性相对较差,可信度Kappa系数为0.362,可重复性平均Kappa系数为0.657。损伤各亚型整体一致性,可信度Kappa系数为0.526,可重复性平均Kappa系数为0.701;其中B2型一致性最差,可信度Kappa系数为0.214,可重复性平均Kappa系数为0.633;其次为A4型,可信度Kappa系数为0.322,可重复性平均Kappa系数为0.685。结论:新型胸腰椎骨折损伤AO分型系统具有中、高度的一致性和极好的可重复性,但对A4和B2型骨折判定的可信度较差。     

胸腰段骨质疏松性骨折严重程度评分评估系统与骨质疏松性骨折分型的可重复性与可信度

目的 对比分析胸腰段骨质疏松性骨折严重程度评分评估系统(TLOFSAS)与骨质疏松性骨折(OF)分型评估胸腰椎骨质疏松性椎体压缩性骨折(OVCF)的可重复性与可信度.方法 选取2017年8月—2019年5月于巴中市中心医院就诊的146例胸腰椎OVCF患者为研究对象.以TLOFSAS与OF分型为标准,由6位脊柱外科医师分别对每例患者的临床资料进行独立评价,2周后再次进行独立评价.收集评估结果,分别行观察者内可重复性及观察者间可信度分析,应用Kappa一致性检验分析TLOFSAS与OF分型的差异性.结果 6位医师使用TLOFSAS共进行1752(146×6×2)次评估,其中<4分876次,4分582次,>4分294次;不同观察者间平均评分一致性为77.4％,平均可信度κ值为0.76,同一观察者内平均评分一致性为79.6％,平均可重复性κ值为0.786.6位医师使用OF分型共进行1752次评估,其中1型224次,2型694次,3型644次,4型154次,5型36次;不同观察者间平均评分一致性为84.3％,平均可信度κ值为0.79;同一观察者内平均评分一致性为85.2％,平均可重复性κ值为0.796.采取TLOFSAS评估的患者手术选择率(90.62％,58/64)高于OF分型(85.29％,58/68),但差异无统计学意义(P>0.05).结论 TLOFSAS与OF分型评估胸腰椎OVCF均具有较好的可重复性和可信度,值得临床推广应用.     

三种胸腰段骨折分类法的可信度和可重复性研究

目的:探讨并比较AO分型、Denis分类、TLICS评分分类系统在胸腰段骨折诊断中的可信度和可重复性。方法:选择临床及影像学资料(X线片、CT、MRI)完整的31例胸腰段骨折患者,将该31例患者的资料提供给6名骨科医生,分别采用AO分型、Denis分类、TLICS评分分类三种方法进行脊柱骨折分类。3个月后进行重复分类。采用加权Cohen′s Kappa系数评价观察者间可信度和观察者内可重复性。结果:AO分型、Denis分类、TLICS评分分类的观察者间平均Kappa系数分别为0.517、0.639、0.713;三种分类方法的观察者内平均Kappa系数分别为0.766、0.832、0.804。结论:三种胸腰段骨折分类方法比较,TLICS评分分类方法的可信度和可重复性较高,Denis分类方法次之,AO分型方法较差,前者更具临床实用价值。     

国际脊柱畸形研究组推荐腰骶椎滑脱分型的可重复性与可信度研究

目的:评估国际脊柱畸形研究组(Spinal Deformity Study Group,SDSG)推荐的腰骶椎滑脱分型的可信度和可重复性。方法:对2001年1月~2010年1月期间我科收治的符合入选标准的53例发育性和峡部裂性腰骶椎滑脱患者的影像学资料进行回顾分析,其中男性12例,女性41例,年龄10~40岁(28.7±10.8岁),每例患者均有完整的术前站立正侧位X线片且均未进行预先测量。由4位脊柱外科医生分别根据SDSG分型标准进行分型,2周后此4位医生分别对这些患者的X线片再次进行分型,收集分型结果,分别作可信度和可重复性分析,计算Kappa值检验一致性。结果:4位医师对53例患者分型的可信度为71.7%~86.8%(Kappa值0.572~0.794),可重复性为83.0%~92.5%(Kappa值0.721~0.891)。滑脱轻、重度分级的可信度和可重复性分别为94.0%(Kappa值0.777)和96.7%(Kappa值0.862)。轻度滑脱患者中分型可信度为86.1%(Kappa值0.744),可重复性为86.6%(Kappa值0.751);重度滑脱患者中分型可信度为83.3%(Kappa值0.693),可重复性为87.5%(Kappa值0.788)。结论:腰骶椎滑脱SDSG分型具有较高的可信度和可重复性,但其在指导手术策略制定中的应用价值尚需进行前瞻性研究进一步检验。     

脊柱转移性肿瘤评分系统及分类

手术治疗脊柱转移性肿瘤已被广泛接受,但对于手术适应证判断、手术方式选择等尚存争议,因此针对脊柱转移性肿瘤的评分、分类有重要临床意义,可指导手术适应证判断及治疗方案制定,临床上以Tomita评分系统、修正的Tokuhashi评分系统应用最为广泛。国际脊柱肿瘤研究小组提出的脊柱肿瘤不稳定评分为临床判断提供了新的思路。该文就脊柱转移性肿瘤评分系统及分类作一综述。     

GAP评分及其对成人脊柱畸形矫形术后力学并发症预测的可信度研究

【摘要】 目的：评估GAP（global alignment and proportion）评分的可信度和可重复性,并探究其在成人脊柱畸形（adult spinal deformity,ASD）矫形术后力学并发症预测中的可靠性。方法：回顾性分析2014年12月~2016年12月在我院行脊柱后路矫形内固定术且随访超过2年的ASD患者98例,其中男性31例,女性67例,年龄38.8±8.6（20~71）岁,随访时间34.4±9.3个月。其中退变性脊柱侧后凸29例、先天性脊柱侧后凸28例、特发性脊柱侧凸19例、创伤后脊柱后凸9例、神经源性脊柱侧凸9例、休门氏病后凸畸形2例,综合征型脊柱侧凸2例（马凡综合征和类马凡综合征各1例）。通过患者术后全脊柱侧位X线片测量骨盆入射角（pelvic incidence,PI）、骶骨倾斜角（sacral slope,SS）、腰椎前凸角（lumbar lordosis,LL）、下腰椎前凸角（lower lumbar lordosis,LLL）和躯干整体倾斜（global tilt,GT）等影像学参数,并计算得出GAP评分,比较GAP评分的观察者间可信度和观察者内可重复性。根据GAP评分结果将患者分为3组：协调组（GAP评分0～2分）;中等不协调组（GAP评分3～6分）;严重不协调组（GAP评分7～13分）,记录所有患者随访中出现的力学并发症,包括内固定失败、近端交界性后凸/失败（proximal junctional kyphosis/failure,PJK/PJF）、远端交界性后凸/失败（distal junctional kyphosis/failure,DJK/DJF）,比较各组间力学并发症的发生率。收集患者术前及末次随访时疼痛视觉模拟评分（visual analogue scale,VAS）、Oswestry功能障碍指数（Oswestry disability index,ODI）问卷表和健康调查简表（the MOS item short form health survey,SF-36）评估结果,比较三组间生活质量评分。结果：3名观察者共进行了588次（98×3×2）次评分,纳入协调组共192（32.7%）次、中等不协调组共250（42.5%）次、严重不协调组共146（24.8%）次。观察者间GAP评分可信度Kappa值为0.765（基本可信）,观察者内可重复性Kappa值为0.822（完全可信）。随访中发现力学并发症15例,包括内固定断裂5例（8.2%）、PJK 9例（9.2%）、螺钉松动1例（1.0%）。协调组、中等不协调组和严重不协调组并发症发生率分别为9.1%（3/33）、14.6%（6/41）和25.0%（6/24）,三组之间差异无统计学意义（χ2=2.74,P=0.254）。三组患者术前生活质量评分未见明显差异（ODI：P=0.167;VAS：P=0.668;SF-36生理功能评分：P=0.896;SF-36心理功能评分：P=0.211）。末次随访时发现ODI（P=0.038）和SF-36生理功能评分（P=0.020）在三组间存在差异,而VAS（P=0.729）和SF-36心理功能评分（P=0.277）无组间差异。结论：GAP评分具有良好的观察者内和观察者间一致性,但评分结果与术后力学并发症发生风险无明显相关性。     

脊柱转移癌术前评估系统的比较

目的　探讨脊柱转移癌的术前评估方法。　方法　 1994年 2月～ 2 0 0 2年 2月 ,共 113例确诊为脊柱转移癌的患者就诊于积水潭医院骨肿瘤科 ,其中 82例患者的临床、影像及病理学资料完整 ,对这些患者分别用Harrington分级系统、Tokuhashi、Tomita及Grubb评分系统进行评估。记录评估结果并对可比结果进行比较。用SPSS软件包进行统计学分析。　结果　由于各评估系统的适用范围有所不同 ,因而有 82例患者可同时用Harrington分级和Tomita评分系统进行评估 ;75例患者可同时用Tokuhashi和Tomita系统进行评估 ;2 5例患者可同时用Tomita系统和Grubb系统进行评估。 (1)在82例患者中 ,Tomita评分认为 92 7% (76例 )的患者有手术治疗的指征 ,而Harrington分级系统则认为只有 6 9 5 %的患者有手术指征 ;经McNemar检验 ,P <0 0 0 1,两种评估系统之间有显著性差异。 (2 ) 75例出现瘫痪和进行性疼痛的患者可以同时用Tokuhashi和Tomita系统进行评估。Tokuhashi评分认为2 0 %的患者可行切除性手术 ,另外 2 0 %的患者可行姑息性手术 ,其余 6 0 %的患者则根据具体情况可行切除或姑息性手术。Tomita评分则认为 4 9 3%的患者可行切除性手术 ,4 2 7%的患者可行姑息性手术 ,剩余的 8 0 %行非手术治疗。 (3)Harrington分级为Ⅰ     

特发性脊柱侧凸的PUMC(协和)分型系统

目的：根据1245例脊柱侧凸建立的数据库，研究特发性脊柱侧凸的新的分型方法，并对新的分型进行临床验证。方法：复习测量了427例有完整资料的特发性脊柱侧凸患者间立位全脊柱正侧位X线生、仰卧位左右Bending像以及术后长期随访的X线片及临床资料，按SRS关于侧凸和侧凸顶点的定义，制定了PUMC（协和）分型系统，并应用PUMC分型方法对以前手术治疗的特发性脊柱侧凸进行重新分型，统计常见各型所占比例及相应融合范围，并对观察者间的可信度和可重复性进行一致性检验。随后用新的分型方法对特发性脊柱侧凸进行前瞻性临床验证，总结并分析其临床效果。结果：按PUMC分型方法将特发性脊柱侧凸分为3型13个亚型，其中PUMC　I型占56．62％，Ⅱ型42．16％，Ⅲ型1．22％。观察者间可信度为85％（Kappa系数0．832），可重复性为91％（Kappa系数0．898）。按此分型方法进行前瞻性研究，临床手术治疗152例，平均随访19．5个月（18－26个月），未发现术后失代偿现象。结论：建立了特发性脊柱侧凸的新的分型方法－PUMC（协和）分型系统，该方法对特发性脊柱侧凸常见的类型及相应的融合范围的临床指导性较强，其可信度、可重复性远高于King分型。     

应用评分测量法评估青少年特发性脊柱侧凸患者的上胸弯

目的 设计脊柱侧凸(adolescent idiopathic scoliosis AIS)患者上胸弯评价量表,并应用其确定上胸弯是否需要融合.方法 由5名脊柱外科医师分别测量29份影像学资料.按照上胸弯冠状面Bending像、矢状面Cobb角和放射学双肩高度差(radiographic shoulder height,RSH)的不同,设定不同的分值(0～3分),设计评分量表.3周后,重复测量,分析量表的可靠性和可重复性.根据患者评分量表得分多少,确定是否需要融合上胸弯,分析此方法的可靠性和可重复性.结果 术前上胸弯冠状面Cobb角、Bending像Cobb角、RSH、矢状面Cobb角的平均得分分别为2.4、2.4、0.2和1.1,总计得分平均为6.0.评分量表的可信度和可重复性平均值分别为:总计得分项均为79.3%(Kappa值0.77);冠状面Cobb角得分项为89.7%(Kappa值0.89)和82.8%(Kappa值0.81);Bending像Cobb角得分项为86.2%(Kappa值0.85)和89.7%(Kappa值0.89);RSH得分项为96.6%(Kappa值0.95)和93.1%(Kappa值0.92);矢状面Cobb角得分项为96.6%(Kappa值0.95).根据评分量表,规定上述评分项单项得分达到3分或总计得分≥4分时,上胸弯需要融合,此方法的可信度和可重复性均为96.6%(Kappa值均为0.95).结论 AIS 上胸弯侧凸参数评分测量法和根据评分确定上胸弯是否需要融合方法可靠性和可重复性良好,可应用于临床.     

PADUA评分系统与保留肾单位手术中相关问题的研究

目的:探讨PADUA评分系统在保留肾单位手术(NSS)中与手术时间、热缺血时间、并发症等相关因素的关系。方法:回顾性分析127例次行NSS的124例肾肿瘤患者的临床资料,行PADUA评分,并利用χ2检验、Fisher确切检验等分析PADUA评分与手术时间、热缺血时间、并发症、出血量、术后住院时间、术后第1天血肌酐变化率的关系。结果:PADUA评分低、中、高度复杂肿瘤分别为40例、62例、25例,LNSS组手术时间与PADUA评分有关(P=0.012),ONSS组只有高度与低度复杂肿瘤之间有统计学意义(P=0.005)。对于低度复杂肿瘤,LNSS比ONSS手术时间短(P=0.009)。PADUA评分与热缺血时间相关,与围手术期并发症、术后第1天血肌酐变化率无关。ONSS组出血量与PADUA评分无关,而LNSS组两者有关(P=0.031)。LNSS组高度比低度复杂肿瘤术后住院时间长。结论:PADUA评分与NSS手术时间、热缺血时间等相关因素密切相关,可以预测手术相关结果,指导肾肿瘤的治疗。     

改良POSSUM评分系统在高龄普外科患者中的应用

目的评价改良POSSUM评分系统在高龄普外科病人中的应用价值。方法回顾性分析245例75岁以上的普外科手术病人的术后并发症率和死亡率，并与改良POSSUM评分系统预测的结果进行比较。结果改良POSSUM评分系统预测的并发症发生率为49.80％，死亡率为14.29％。实际并发症发生率为35.51％，死亡率为4.89％。结论在高危组病例中改良POSSUM评分系统更具有使用价值。     

Risk scoring system for predicting breast conservation after neoadjuvant chemotherapy

We developed a risk scoring system (RSS) for predicting breast conservative surgery (BCS) in women receiving neoadjuvant chemotherapy(NAC) for breast cancer. BCS rate in the training set was 32.6%, associated with five variables: age < 50years, primary radiological tumor diameter < 60mm, absence of multifocality, absence of breast inflammation and hormone receptor status. These variables were assigned scores ranging from 0 to 9. The discrimination of the RSS was 0.78(95%CI 0.69‐0.86) in the training set. The area under the curve of the receiver operating characteristics for predicting BCS after internal and external validation was 0.77(95%CI 0.68‐0.85) and 0.75(95%CI 0.66‐0.84), respectively.     

APACHE-II scoring system in perforative peritonitis

BACKGROUND: Prospective assessment of the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) scoring system of stratification of disease severity has been shown to provide objective discrimination between low-risk and high-risk groups of patients with intra-abdominal sepsis. The current study was undertaken to evaluate the performance of APACHE-II score in prediction of mortality risk in patients with peritonitis due to hollow viscus perforation. STUDY DESIGN: Fifty patients admitted to a teaching hospital with peritonitis due to hollow viscus perforation were prospectively studied over a 2-year period. APACHE-II points were assigned to all patients in order to calculate their individual risk of mortality before undergoing emergency surgery. The accuracy in outcome prediction of the APACHE-II system was assessed by means of receiver operating characteristic (ROC) curve and the Pearson correlation coefficient and its significance test. RESULTS: Of the 50 patients admitted during the study period, there were 42 (84%) survivors and 8 (16%) nonsurvivors. Mean APACHE-II score of the study population was 11.38 with a range of 1 to 23. The predicted death rate was 23% and the observed death rate was 16%. Mean APACHE-II score in survivors was 9.88, whereas in nonsurvivors it was 19.25. Using ROC analysis, the area under the curve was found to be .984. Correlation of APACHE-II score and predicted death rate showed perfect correlation, with r = .99 and P <.001 [R2 = .9993]. APACHE-II score between 11 and 15 showed a sensitivity and specificity of 100% and 73.8%, respectively, and APACHE-II score of 16 to 20 had a sensitivity and specificity of 87.5% and 100%, respectively. CONCLUSION: APACHE-II score between 11 and 20 was shown to be a better predictor of risk of mortality in patients with peritonitis due to hollow viscus perforation. Predicted mortality did not correlate with observed mortality in patients with APACHE-II scores of 1 to 10 and greater than 20. The APACHE-II scoring system can be used to assess group outcomes in patients with peritonitis due to hollow viscus perforation. However, it does not provide sufficient confidence for outcome prediction in individual patients.     

Early prediction of acute kidney injury after liver transplantation by scoring system and decision tree

Background and aimsEarly detection of acute kidney injury (AKI) is crucial for the prognosis of patients after liver transplantation (LT). This passage aims to analyze the perioperative clinical markers of AKI after LT and establish predictive models based on clinical variables for early detection of AKI after LT.MethodsWe prospectively collected 109 patients with LT, and compared the differences of perioperative clinical markers between the AKI group and non-AKI group. The scoring system and decision tree model were established through the risk factors. Another 163 patients who underwent LT in the same center from 2017 to 2018 were retrospectively collected to verify the models.ResultsIn multiple comparisons of risk factors of post-LT AKI, pre-operative factors were excluded automatically, intraoperative and post-operative factors including operating time, intraoperative hypotension time, post-operative infection, the peak of post-operative AST, and post-operative shock were the independent risk factors for post-LT AKI. The scoring system established with the risk factors has good predictive power (AUC = 0.755) in the validation cohort. The decision tree also shows that post-operative shock was the most important marker, followed by post-operative infection.ConclusionFive intraoperative and post-operative factors are independently associated with post-LT AKI rather than pre-operative factors, which indicates that operation technique and post-operative management may more important for the prevention of post-LT AKI. The scoring system and decision tree model could complement each other, and provide quantitative and intuitive prediction tools for clinical practice of early detection of post-LT AKI.     

结直肠癌肝转移预后评分系统的现状及临床应用

结直肠癌是中国第二常见的恶性肿瘤,其中约50％的患者最终会发生肝转移。有效的全身治疗和积极包括手术在内的局部治疗,是提升结直肠癌肝转移患者疗效的关键。肝切除术后复发是导致结直肠癌肝转移患者死亡的主要原因,不同复发风险的患者治疗选择也有所不同,因此建立有效的结直肠癌肝转移预后评分系统,以指导其个体化治疗至关重要。临床危险评分（CRS）是目前结直肠癌肝转移患者应用最广泛的预后评分系统。其他预后评分系统还包括肿瘤负荷评分（TBS）、GAME评分、CERR评分等。预后评分系统的不断完善可以更好地帮助临床医生预测结直肠癌肝转移病人预后,对高危患者采取更积极的干预手段,合理有效地延长患者生命。     

New scoring system for differentiating xanthogranulomatous cholecystitis from gall bladder carcinoma: a tertiary care centre experience

Background

Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis, characterized by a focal or diffuse destructive inflammatory process. The importance of XGC is that it mimics gall bladder carcinoma (GBC) both preoperatively and intra‐operatively, as it can present with pericholecystic infiltration, hepatic involvement and lymphadenopathy. As a result of a misdiagnosis, which is not infrequent, the patient may undergo an unnecessary radical cholecystectomy rather than only a cholecystectomy, which is associated with a greater morbidity and mortality. The main aim of the study is to formulate a simple preoperative scoring system for diagnosis of XGC which might benefit patients by avoiding radical procedures.

Methods

A retrospective study was done from all the patients who underwent gall bladder and gall bladder‐related operations (benign and malignant), during a 5‐year time period from 2010 to 2014 in a tertiary care centre were reviewed (n = 462).

Results

Initial analyses of all the clinical and imaging parameters were done. Patients with a long history of recurrent abdominal pain with leucocytosis and who on imaging are found to have a diffusely thickened gall bladder wall, cholelithiasis, choledocholithiasis and submucosal hypoattenuated nodules are likely to have XGC while those with anorexia, weight loss, focal thickening of the gall bladder wall on imaging and dense local organ infiltration are more likely to have GBC. The presence of lymph nodes on imaging and the loss of a fat plane interface between the liver and gall bladder are not differentiating factors. A scoring system was made by taking statistically significant features (n = 13) of clinical and imaging parameters in initial assessment to identify the features of XGC. The same scoring system was subsequently applied to the patients who underwent cholecystectomy to study the effectiveness and the results were reviewed.

Conclusion

High value scores (≥11/13) helps in diagnosing XGC in preoperative setting. Hence, intra‐operative frozen section analysis can be avoided in such cases to differentiate XGC and GBC. However in difficult cases with high suspicion of malignancy based on clinical experience, definitive diagnosis still remains a histopathological examination to avoid radical resection in patients who have a benign condition.     

Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome

Objective There is no objective means to assess the obstructed defaecation syndrome (ODS), to allow evaluation of outcome or to compare the efficacy of treatment including surgery. The study aimed to validate a disease‐specific index to quantify severity to allow assessment of the results of treatment in clinical trials, to permit comparison between them. Method Seventy‐six patients with ODS and 30 healthy controls entered the study after proctologic and ano‐rectal physiological investigation. Hirschsprung's disease and slow transit constipation were excluded. An eight‐item questionnaire with four or five possible answers was administered by two independent researchers at two different times. The ODS score was the sum of all points with a maximum possible of 31 points. Agreement between the two operators was evaluated by the Kappa coefficient for each single item. The coefficient of repeatability (CR) was assessed by the Bland and Altman plot. The internal consistency was evaluated by the Crohnbach‐alpha test. A cluster analysis was carried out on each clinical finding. The Mann–Whitney U‐test was used to compare median ODS score between patients and controls. Results The ODS score of the two operators was normally distributed and strongly correlated (r = 0.89). The correlation coefficient between the score assigned to each item by two operators ranged from 0.79 to 0.98. The degree of agreement between the operators was good and the two methods were reproducible (CR = 3.13). There was a significant difference between the mean ODS score for patients and controls (t = 20.70, P < 0.001). The Crohnbach alpha value for internal reliability was +0.513. Cluster analysis showed a different profile between cluster 1 (a nonhomogenous group including rectocoele, intussusception or perineal descent), and cluster 2 (pelvic dysynergia). Conclusion The ODS score offers a validated severity of disease index in grading the severity of disease and monitoring the efficacy of therapy.