摘要
目的 分析喉癌患者喉部分切除术后喉狭窄发生的危险因素,并构建风险预测模型。方法 回顾性收集160例行喉部分切除术治疗的喉癌患者病历资料,统计患者术后6个月内喉狭窄发生情况,将发生喉狭窄的患者归入狭窄组,其余患者归入不狭窄组。通过单因素、多因素分析探讨喉癌患者喉部分切除术后喉狭窄的影响因素,基于上述因素构建风险预测模型,通过Bootstrap内部验证法、校准曲线、受试者工作特征曲线(ROC)检验风险预测模型的区分度、准确度及预测价值。结果 狭窄组中糖尿病、未放置喉硅胶膜、甲状腺软骨支架切除范围≥1/2的患者占比均高于不狭窄组,颈前气管套管拔管时间长于不狭窄组,差异有统计学意义(P<0.05)。经Logistic回归分析显示,合并糖尿病、未放置喉硅胶膜、颈前气管套管拔管时间长、甲状腺软骨支架切除范围≥1/2是喉癌患者喉部分切除术后喉狭窄发生的危险因素(P<0.05)。采用Bootstrap内部验证法验证预测模型的区分度,C-index=0.914,提示该模型具有良好区分度;校准曲线和Y-X直线相近,提示模型准确度良好。ROC曲线显示,风险预测模型评估喉癌患者喉部分切除术后喉狭窄发生的曲线下面积(AUC)为0.914,特异度为0.946,敏感度为0.833,预测价值较高。结论 喉癌患者喉部分切除术后喉狭窄发生与合并糖尿病、未放置喉硅胶膜、颈前气管套管拔管时间长、甲状腺软骨支架切除范围≥1/2有关,基于上述因素构建的风险预测模型可较好地预测喉癌患者喉部分切除术后喉狭窄发生的风险。
Objective To analyze the risk factors for postoperative laryngeal stenosis in patients with laryngeal cancer undergoing partial laryngectomy and construct a risk prediction model.Methods A retrospective collection of medical records was conducted on 160 patients with laryngeal cancer who underwent partial laryngectomy.The occurrence of laryngeal stenosis within 6 months after surgery was analyzed,and patients with laryngeal stenosis were classified into the stenosis group,while the remaining patients were classified into the non stenosis group.The influential factors of laryngeal stenosis after partial laryngectomy in laryngeal cancer patients were investigated through single factor and multi-factor analysis,and a risk prediction model was constructed based on the above factors.The differentiation,accuracy and prediction value of the risk prediction model were tested by Bootstrap internal verification method,calibration curve and receiver operating characteristic curve(ROC).Results The proportion of diabetes in the stenosis group,the proportion of silicone membrane not placed in the larynx,the proportion of thyroid cartilage stent removal range≥1/2 in the stenosis group were all higher than those in the non stenosis group,and the extubation time of anterior cervical tracheal cannula was longer than that in the non stenosis group,with statistical significant differences(P<0.05).Logistic regression analysis showed that the risk factors for laryngeal stenosis after partial laryngectomy in patients with laryngeal cancer were diabetes,no placement of laryngeal silicone membrane,long time of extubation of anterior cervical tracheal cannula,and the removal range of thyroid cartilage stent≥1/2(P<0.05).Bootstrap internal validation method was used to verify the discriminative power of the prediction model,C-index=0.914,indicating that the model had good discriminative power.Standard curve was drawn,the calibration curve was close to the Y-X line,indicating good model accuracy.The ROC curve showed that the area under the curve(AUC)of the risk prediction model for assessing the occurrence of laryngeal stenosis after partial laryngectomy in laryngeal cancer patients was 0.914,with a specificity of 0.946 and a sensitivity of 0.833,indicating a high predictive value.Conclusion The occurrence of laryngeal stenosis after partial laryngectomy in patients with laryngeal cancer is related to the combination of diabetes,no placement of laryngeal silicone membrane,long extubation time of anterior cervical tracheal cannula,and the removal range of thyroid cartilage stent≥1/2.The risk prediction model based on the above factors can better predict the risk of laryngeal stenosis after partial laryngectomy in patients with laryngeal cancer.
作者
阮兰红
王玉丹
马敬
RUAN Lanhong;WANG Yudan;MA Jin(The First Affiliated Hospital of Henan University of Science and Technology,Luoyang,471000)
出处
《实用癌症杂志》
2025年第7期1117-1121,共5页
The Practical Journal of Cancer
基金
河南省医学科技攻关计划项目(编号:LHGJ20210607)。
关键词
喉癌
喉部分切除术
喉狭窄
预测模型
Laryngeal cancer
Partial laryngectomy
Laryngeal stenosis
Prediction model
