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摘要: 目的 探讨影响重度气管狭窄手术疗效的危险因素。方法 回顾性分析36例重度气管狭窄患者资料，均行袖状切除狭窄段气管，端端吻合。对患者气管狭窄部位、切除气管长度、狭窄程度、瘢痕体质、糖尿病、胃食管反流病等6个因素与术后拔管率进行单因素分析及多因素Logistic回归分析。结果 成功拔管23例，其中19例一次性拔管, 4例经支撑喉镜切除肉芽组织后成功拔管。单因素分析表明气管狭窄部位、切除气管长度、瘢痕体质、糖尿病、胃食管反流病是影响重度气管狭窄手术疗效的危险因素，各个因素的多因素Logistic回归系数分别为2.857、1.761、3.123、-1.066、3.545。结论 气管狭窄部位、切除气管长度、瘢痕体质、糖尿病、胃食管反流病是影响端端吻合术治疗重度气管狭窄拔管率的危险因素，其中狭窄部位、切除气管长度、瘢痕体质、胃食管反流病对手术预后的影响更显著，术前对上述危险因素进行综合评估，有利于提高手术疗效。Abstract: Objective To investigate the risk factors affecting the surgical outcome of severe tracheal stenosis.Methods The data of 36 patients with severe tracheal stenosis were analyzed retrospectively. All patients underwent tracheal stenosis resection with primary end-to-end anastomosis.Six factors including the location of tracheal stenosis, the length of resected trachea, the degree of stenosis, scar constitution, diabetes and gastroesophageal reflux disease were analyzed by univariate analysis and multivariate Logistic regression analysis.Results Finally, 23 cases were extubated, including 19 cases with successful extubation and 4 cases with granulation tissue removed by bracing laryngoscope.Univariate analysis showed that the location of tracheal stenosis, the length of resected trachea, scar constitution, diabetes and gastroesophageal reflux disease were the risk factors affecting the surgical efficacy of severe tracheal stenosis.The multivariate Logistic regression coefficients of each factor were 2.857, 1.761, 3.123, -1.066, 3.545 respectively.Conclution The risk factors affecting the outcome of severe tracheal decannulation rate were the location of tracheal stenosis, the length of resected trachea, scar constitution, diabetes and gastroesophageal reflux disease. Among them, the stenosis position, the length of the resected trachea, scar constitution and gastroesophageal reflux disease had more significant effects on the prognosis of the operation, and the comprehensive evaluation of these risk factors before operation was conducive to improve the surgical effect.
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Key words:
- tracheal stenosis /
- T tube /
- dangerous factors
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表 1 36例入组患者的术前情况及预后总结
特征变量 例数(%) 特征变量 例数(%) 是否拔管 程度 是 23(63.9) Ⅲ 24(66.7) 否 13(36.1) Ⅳ 12(33.3) 狭窄部位 瘢痕体质 近 15(41.7) 有 16(44.4) 远 21(58.3) 无 20(55.6) 切除气管长度 糖尿病 < 3 cm 22(61.1) 有 18(50.0) ≥3 cm 14(38.9) 无 18(50.0) 胃食管反流病 有 14(38.9) 无 22(61.1) 
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表 2 各危险因素对拔管率的单因素分析
危险因素 是否拔管 χ2 P 否
(n =13)是
(n =23)狭窄部位 14.406 0.001 近 10(76.9) 5(21.7) 远 3(23.1) 18(78.3) 切除气管长度 4.392 0.036 < 3 cm 5(38.5) 17(73.9) ≥3 cm 8(61.5) 6(26.1) 狭窄程度 3.853 0.071 Ⅲ 6(46.2) 18(78.3) Ⅳ 7(53.8) 5(21.7) 瘢痕体质 13.298 0.000 有 11(84.6) 5(21.7) 无 2(15.4) 18(78.3) 糖尿病 5.900 0.015 有 10(76.9) 8(34.8) 无 3(23.1) 15(65.2) 胃食管反流病 12.386 0.001 有 10(76.9) 4(17.4) 无 3(23.1) 19(82.6)
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表 3 影响术后拔管的多因素Logistic回归分析
影响因素 回归系数 S.E. Wals df P OR 95%CI 狭窄部位 2.857 1.447 3.9 1 0.048 17.408 1.022~296.598 切除气管长度 1.761 1.567 1.262 1 0.261 5.818 0.270~125.529 瘢痕体质 3.123 1.508 4.291 1 0.038 22.724 1.183~436.430 糖尿病 -1.066 1.464 0.531 1 0.466 0.344 0.020~6.065 胃食管反流病 3.545 1.552 5.215 1 0.022 34.633 1.653~725.786
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| 引用本文: |
何婷, 朱文颖, 江远明, 等. 影响重度气管狭窄手术疗效的危险因素[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(3): 238-241. doi: 10.13201/j.issn.2096-7993.2021.03.010
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| Citation: |
HE Ting, ZHU Wenying, JIANG Yuanming, et al. Risk factors affecting the surgical outcome of severe tracheal stenosis[J]. J Clin Otorhinolaryngol Head Neck Surg, 2021, 35(3): 238-241. doi: 10.13201/j.issn.2096-7993.2021.03.010
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