ISSN 1673-3770 CN 37-1437/R
山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (4): 87-91.doi: 10.6040/j.issn.1673-3770.0.2019.373
陈东1,余红2,李洋1,黄强1,方敏1
This study was conducted to explore the preoperative risk factors for postoperative adhesion in patients with chronic rhinosinusitis(CRS)undergoing functional endoscopic sinus surgery(FESS), and to construct a risk score model to evaluate their predictive effect. MethodsA retrospective study was conducted on 323 patients with CRS who underwent FESS at our hospital between January 2015 and June 2018. The risk factors for postoperative adhesion were screened using a multivariate logistic regression analysis. The risk score was assigned according to the odds ratio(OR)value, and a receiver operating characteristic(ROC)curve was drawn to evaluate the predictive effect. ResultsPostoperative adhesion occurred in 35 patients(10.8%). The logistic regression results showed that concha bullosa, primary FESS, operative experience less than 10 years, and a history of middle turbinate resection were independent risk factors for postoperative adhesion in FESS. The OR values were 1.12(95% CI: 1.06-1.18), 3.87(95% CI: 2.23-5.51), 3.19(95% CI: 2.07-4.31), and 2.24(95% CI:1.95-2.53), respectively. The risk score model assigned 1 point for vesicular middle turbinate, 4 points for first time FESS, 3 points for operative experience less than 10 years, and 2 points for middle turbinate resection. The ROC curve analysis showed that the area under the curve(AUC)was 0.784(95% CI: 0.672-0.896, P<0.05). When 4 points were selected as the cut-off point, the Jordan index was the largest, with a sensitivity of 75.1% and a specificity of 73.6%. ConclusionThe incidence of postoperative adhesion in 323 patients with CRS who underwent FESS was 10.8%. The risk score model has certain reference value for predicting high-risk postoperative adhesion.
摘要： 目的 探究行功能性鼻内窥镜鼻窦手术(FESS)的慢性鼻-鼻窦炎(CRS)患者发生术后粘连的术前危险因素,并构建风险评分模型,评价预测效果。 方法 对2015年1月至2018年6月进行过FESS的323例CRS患者进行回顾性分析。采用病例对照研究方法分析术后粘连的危险因素,采用多因素Logistic回归分析筛选影响因素,根据比值比(OR)值进行发病风险赋值,并绘制ROC曲线评价预测效果。 结果 35例(10.8%)患者发生术后粘连。Logistic回归结果显示泡状中鼻甲、首次行FESS、术者经验<10年以及中鼻甲切除史是FESS术后粘连的独立危险因素,OR值分别为1.12(95% CI:1.06~1.18)、3.87(95% CI:2.23~5.51)、3.19(95% CI:2.07~4.31)、2.24(95% CI:1.95~2.53)。发病风险评分模型为泡状中鼻甲赋值1分、首次行FESS赋值4分、术者经验<10年赋值3分以及中鼻甲切除史赋值2分。ROC曲线分析表明,曲线下面积(AUC)为0.784(95% CI:0.672~0.896,P<0.05),选择4分作为截断值时,约登指数最大,此时灵敏度为75.1%,特异度为73.6%。 结论 323例CRS患者行FESS术后粘连的发生率为10.8%,风险评分对预判术后粘连高风险者有一定的参考价值。
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