老年患者低温等离子术后声带粘连的原因分析及预测模型构建

Analysis of causes of vocal cord adhesion in elderly patients after low-temperature plasma surgery and construction of a predic-tive model

中文关键词: 老年  喉部病变  低温等离子  声带粘连  危险因素  预测模型  列线图

英文关键词: elderly  laryngeal lesion  low-temperature plasma  vocal cord adhesions  risk factor  predictive model  no-mogram

中文摘要:

      目的 分析老年喉部病变患者经低温等离子手术后出现声带粘连的原因并构建列线图预测模型.方法 回顾性收集2018年1月-2023年6月郑州大学第一附属医院咽喉头颈外科214例行低温等离子手术治疗的老年喉部病变患者的临床资料,统计分析声带粘连发生情况与患者性别、年龄、吸烟、饮酒、胃食管反流、病变类型、病变部位、手术范围、手术时间、术后肉芽形成等因素的相关性,应用Logistic回归分析探讨喉部等离子术后出现声带粘连的独立危险因素.应用R语言建立列线图预测模型,并采用Bootstrap方法验证该模型的预测效能.结果 在214例患者中,55例术后出现声带粘连,其中病变部位、手术范围、术后肉芽形成是喉部等离子术后出现声带粘连的独立危险因素(P＜0.05).ROC曲线显示构建的列线图对预测喉部等离子术后出现声带粘连的区分度较好(AUC=0.863,95％CI=0.785～0.940),Bootstrap方法对列线图进行验证,校准曲线平均绝对误差为0.04,表明校准曲线与理想曲线贴合度良好.结论 病变部位、手术范围及术后肉芽形成是老年喉部病变患者经低温等离子手术后声带粘连发生的独立危险因素,根据以上危险因素构建的列线图模型对声带粘连的发生有较好的预测价值,有助于指导手术方式的选择及术后声带粘连的监测.

英文摘要:

      Objective To analyze the causes of vocal cord adhesion after low-temperature plasma surgery in elderly pa-tients with laryngeal lesions and construct a nomogram prediction model.Methods The clinical data of 214 elderly patients with laryngeal lesions who underwent low-temperature plasma surgery in Department of Throat,Head and Neck Surgery,First Affiliated Hospital of Zhengzhou University were retrospectively collected.Statistical analysis was performed to assess correla-tions between vocal cord adhesion and factors including gender,age,smoking,alcohol consumption,gastroesophageal reflux,lesion type,lesion location,surgical scope,operative time,and postoperative granuloma formation.Logistic regression analy-sis was used to identify independent risk factors for vocal cord adhesion after laryngeal plasma surgery.A nomogram prediction model was established using R language,and its predictive performance was validated by Bootstrap method.Results Among the 214 patients,55 ones developed vocal cord adhesion after surgery.Lesion location,surgical scope and postoperative granu-loma formation were identified as independent risk factors for vocal cord adhesion after laryngeal plasma surgery(P＜0.05).The ROC curve showed that the constructed nomogram had a good discrimination in predicting vocal cord adhesion after laryn-geal plasma surgery(AUC=0.863,95％CI=0.785-0.940).The Bootstrap method was used to verify the nomogram,and the average absolute error of the calibration curve was 0.04,indicating that the calibration curve had a good fit with the ideal curve.Conclusion The lesion location,surgical scope and postoperative granulation formation are independent risk factors for the occurrence of vocal fold adhesion in elderly patients with laryngeal lesions after low-temperature plasma surgery.The con-structed nomogram model based on these factors exhibits strong predictive value for vocal cord adhesion occurrence,and it is helpful to guide the selection of surgical methods and the monitoring of postoperative vocal cord adhesions.