早期喉癌术后发生吞咽功能障碍的影响因素及列线图模型构建  

Influence factors and construction of nomogram model of swallowing dysfunction after early laryngeal cancer surgery

作　　者：钱南南 韩锦凯 孙明鹏 QIAN Nannan;HAN Jinkai;SUN Mingpeng(Department of Otorhinolaryngology Head and Neck Surgery,Fuyang People′s Hospital,Fuyang Anhui 236000,China)

机构地区：[1]安徽省阜阳市人民医院耳鼻咽喉头颈外科,安徽阜阳236000

出　　处：《新疆医科大学学报》2024年第12期1609-1615,共7页Journal of Xinjiang Medical University

基　　金：安徽省自然科学基金项目(2023byzd221)。

摘　　要：目的探讨早期喉癌手术后引发吞咽功能障碍的影响因素,并构建列线图模型。方法回顾性分析2020年1月至2023年12月安徽省阜阳市人民医院接受早期喉癌术治疗的183名患者的临床资料。根据术后患者是否存在吞咽功能障碍,将患者分为病例组(吞咽功能受损者)和对照组(吞咽功能未受损者)。通过单因素和多因素Logistic回归分析,筛选出早期喉癌术后发生吞咽功能障碍的影响因素,构建列线图模型并评估其预测效能。结果183名早期喉癌患者术后发生吞咽功能障碍的共59人(32.24%),其余124人(67.76%)未出现吞咽功能障碍。单因素分析结果显示,早期喉癌术后发生吞咽功能障碍与未发生吞咽功能障患者年龄、咽喉反流病史、手术方式、张口受限程度、手术后1周内的最高疼痛程度评分比较,差异均有统计学意义(P<0.05)。多因素分析结果显示,上述因素均为早期喉癌术后发生吞咽功能障碍的独立影响因素(P<0.05)。基于以上6种因素构建列线图模型,其一致性指数(CI)为0.814,标准校正曲线平均误差为0.014。年龄、咽喉反流病史、手术方式、张口受限程度、手术后1周内的最高疼痛程度评分、列线图模型预测早期喉癌术后发生吞咽功能障碍的受试者工作特征(ROC)曲线下面积(AUC)分别为0.736、0.748、0.630、0.848、0.706、0.957,显示该模型具有较高预测效能。结论本研究构建的列线图模型可有效预测早期喉癌患者术后吞咽功能障碍的风险,有助于帮助早期喉癌患者提前进行风险管理和制定个性化治疗方案,提升喉癌患者的术后生活质量。ObjectiveTo explore the factors influencing swallowing dysfunction after early laryngeal cancer surgery and to develop a nomogram model.MethodsData of 183 patients with early laryngeal cancer treatedin the hospital from January 2020 to December 2023 were retrospectively analyzed.According to whether the patients had swallowing dysfunction after the the surgery,the patient were divided into case group(those with swallowing dysfunction)and the control group(those without swallowing dysfunction).Univariate and multivariate Logistic regression analyses were conducted to screen out the factors of swallowing dysfunction after early laryngeal cancer surgery.A nomogram model was developed and its predictive performance was evaluated.ResultsAmong the 18 patients with early laryngeal cancer,59(32.24%)developed swallowing dysfunction after the surgery,while the remaining 124(67.76%)did not.The univariate analysis showed that the age of the patients,history of laryngopharyngeal reflux,surgical,degree of trismus and the highest pain score within 1 week after the surgery were significantly different between the patients who developed swallowing dysfunction and those who did not(P<0.05).The multivariate analysis showed that all these factors were independent influencing factors for swallowing dysfunction after early laryngeal cancer surgery(P<0.05).A nomogram model was constructed based on the above 6 factors,with a concordance index(CI)of 0.814 and an average error of the standard calibration curve of 0.014.Age,history of laryngopharyngeal reflux,surgical approach,degree of trismus,highest pain score within 1 week surgery,and the area under the receiver operating characteristic(ROC)curve for predicting dysphagia after early laryngeal cancer surgery using the nomogram were 0.736,0.748,0.630,0.848,0.06 and 0.957,respectively,indicating that the model has high predictive accuracy.ConclusionThe nomogram model constructed in this study can effectively predict the risk of postoperative swallowing dysfunction in patients with early l

关 键 词：喉癌 吞咽功能障碍 列线图模型 

分 类 号：R739.65[医药卫生—肿瘤]