CO_(2)激光下切除声带任克氏间隙水肿并发声带粘连的危险因素分析及预防策略  

Risk Factors Analysis and Prevention Strategy of Renke Space Edema Complicated with Vocal Cord Adhesion After CO_(2) Laser Resection

作　　者：孙小龙[1] 李晓洋[1] 郭娟丽[1] 董静 朱丽娜[1] SUN Xiao-long;LI Xiao-yang;GUO Juan-li;DONG Jing;ZHU Li-na(Department of Otorhinolaryngology,The Second Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)

机构地区：[1]河南科技大学第二附属医院耳鼻咽喉科,河南洛阳471000

出　　处：《中山大学学报（医学科学版）》2023年第2期310-317,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：山东省重点研发计划(2016GSF201077)。

摘　　要：[目的]探讨CO_(2)激光下切除声带任克氏间隙水肿并发声带粘连的危险因素分析及预防策略。[方法]回顾性选取2018年6月至2021年6月于本院行CO_(2)激光切除双侧声带任克氏间隙水肿患者70例作为研究对象。根据术后患者声带粘连情况分为声带粘连组(35例)和无声带粘连组(35例),比较两组患者的一般资料,多因素lo⁃gistic回归分析评价患者术后声带粘连的危险因素;采用卡方自动交互检测(CHAID)分类树算法建立患者术后声带粘连发病风险的预测模型,收益图、索引图评价模型的应用价值。[结果]多因素分析结果显示,手术范围及深度为Ⅱ级、激光功率≥5 W、前连合受累为患者术后声带粘连的危险因素[OR 95%CI分别为:6.113(2.346,17.451);5.214(1.469,15.263);18.651(1.689,36.203)]。分类树模型显示,前连合受累是患者术后声带粘连的重要预测因素(76.92%;χ^(2)=11.993,P=0.001),收益图和索引图显示模型预测良好。[结论]临床应重点关注患者手术范围及深度、激光功率和前连合受累,及时制定预防策略,以期降低患者声带粘连的发病风险。[Objective]To investigate the prevention strategy of bilateral vocal cord adhesion after simultaneous Renke space edema resection under CO_(2) laser.[Methods]Seventy patients who underwent CO_(2) laser resection of bilateral Renke space edema of vocal cords from June 2018 to June 2021 in our hospital were retrospectively selected for this study.Accord⁃ing to their postoperative vocal cord adhesion,patients were divided into vocal cord adhesion group(35 cases)and silent band adhesion group(35 cases),and the general data of the two groups were compared.Multivariate logistic regression analysis was used to evaluate the risk factors for postoperative vocal cord adhesion.The prediction model of postoperative morbidity risk of vocal cord adhesion was established by using chisquared automatic interaction detection(CHAID)classi⁃fication tree algorithm,and the application value of the model was evaluated by benefit graph and index graph.[Results]Multivariate analysis showed that surgical range and depth ofⅡ,laser power≥5 W and anterior connection involvement were the risk factors for postoperative vocal cord adhesion[OR 95%CI:6.113(2.346,17.451);5.214(1.469,15.263);18.651(1.689,36.203)].The classification tree model showed that anterior articulation involvement was an important pre⁃dictor of postoperative vocal cord adhesion (76.92%;χ^(2)=11.993, P=0.001), and the benefit graph and index graph showed good models.[Conclusion] Clinical attention should be paid to surgical scope and depth, laser power and anterior union involvement, and timely prevention strategies should be formulated to reduce the risk of vocal cord adhesion in patients.

关 键 词：CO_(2)激光 双侧声带任克氏间隙水肿 声带粘连 分类树算法 预测模型 

分 类 号：R767.4[医药卫生—耳鼻咽喉科]