Abstract:

Objective　To analyze the recurrence of patients with otitis media after otoendoscopic surgery and its influencing factors, and to construct and verify a prediction model. Methods　A retrospective analysis was performed on 220 patients with otitis media who underwent otoendoscopic treatment in Yan'an People's Hospital from June 2020 to August 2022, including 108 males and 112 females. They were 30-80 years old. Their disease course was 14-35 months. The patients were followed up for 1 year to observe their postoperative recurrence, and they were divided into a recurrence group (36 cases) and a non-recurrence group (184 cases). The patients' clinical data were collected. Univariate analysis and multivariate logistic analysis were used to analyze the factors affecting their postoperative recurrence, and a nomogram model was constructed. The receiver operating characteristic curve (ROC) was used to analyze the model's prediction efficiency.t and χ² tests were used for the statistical analysis. Results　The patients' recurrence rate within 1 year after the surgery was 16.36% (36/220). The results of univariate analysis showed that the proportion of the patients with ventilation tube retention for 6-12 months in the recurrence group was lower than that in the non-recurrence group, and the proportions of the patients with smoking history, upper respiratory tract infection ≥4 times/year, chronic sinusitis, adenoid hypertrophy, mastoid dysplasia, and eustacia tube dysfunction in the recurrence group were higher than those in the non-recurrence group [58.33% (21/36) vs. 39.13% (72/184), 83.33% (30/36) vs. 62.50% (115/184), 80.56% (29/36) vs. 53.26% (98/184), 63.89% (23/36) vs. 35.87% (66/184), 61.11% (22/36) vs. 38.59% (71/184), and 69.44% (25/36) vs. 35.87% (66/184)], with statistical differences (all P0.05). The binary logistic regression analysis showed that ventilation tube retention time (OR=0.294, 95%CI 0.107-0.806) was an independent protective factor for the patients' postoperative recurrence, and chronic sinusitis (OR=4.226, 95%CI 1.794-9.952), adenoid hypertrophy (OR=5.336, 95%CI 1.805-15.773), and eustachian tube function (OR=4.851, 95%CI 2.535-9.280) were independent risk factors for their postoperative recurrence (all P0.05). The internal verification of the nomogram prediction model built based on the above influencing factors showed that the C-index index was 0.832 (95%CI 0.785-0.926), and the correction curve for predicting their postoperative recurrence was close to the ideal curve (P0.05). The ROC results showed that the sensitivity and specificity of the nomogram model for predicting their postoperative recurrence were 83.30% and 84.80%, and the AUC was 0.878 (95%CI 0.804-0.952;P0.05). Conclusions　Ventilation tube retention time is an independent protective factor for recurrence after otitis media endoscopic surgery, while chronic sinusitis, adenoid hypertrophy, and eustachian tube function are independent risk factors. The nomogram risk prediction model based on the above factors can evaluate the risk of postoperative recurrence well.

Key words:

Otitis media, Otoendoscopic surgery, Postoperative recurrence, Influencing factors, Risk prediction model, Nomogram

摘要：

目的　分析中耳炎患者耳内镜手术后复发情况及其影响因素，并以此构建预测模型并验证。方法　回顾性分析，选取2020年6月至2022年8月延安市人民医院收治的220例行耳内镜治疗的中耳炎患者作为研究对象，其中男108例、女112例，年龄30～80岁，病程14～35个月。术后对患者进行为期1年随访，观察患者术后复发情况，并将其分为复发组（36例）和无复发组（184例）。收集患者临床相关资料，采用单因素及多因素logistic回归法分析患者术后复发的影响因素，并构建Nomogram列线图模型；受试者操作特征曲线（ROC）评估模型预测效能。统计学方法采用t检验、χ²检验。结果　中耳炎患者耳内镜术后1年内复发率为16.36%（36/220）。单因素分析结果显示，复发组通气管留置时间为6～12个月占比低于无复发组［27.78%（10/36）比59.24%（109/184）］，吸烟史、上呼吸道感染≥4次/年、伴慢性鼻窦炎、腺样体肥大、乳突气化不良、咽鼓管功能不良占比均高于无复发组［58.33%（21/36）比39.13%（72/184）、83.33%（30/36）比62.50%（115/184）、80.56%（29/36）比53.26%（98/184）、63.89%（23/36）比35.87%（66/184）、61.11%（22/36）比38.59%（71/184）、69.44%（25/36）比35.87%（66/184）］，差异均有统计学意义（均P0.05）。二元logistic回归分析结果显示，通气管留置时间（OR=0.294，95%CI 0.107～0.806）是患者术后复发的独立保护因素，伴慢性鼻窦炎（OR=4.226，95%CI 1.794～9.952）、腺样体肥大（OR=5.336，95%CI 1.805～15.773）、咽鼓管功能（OR=4.851，95%CI 2.535～9.280）是术后复发的独立危险因素（均P0.05）。基于上述影响因素构建的列线图预测模型经Bootstrap法内部验证显示，C-index指数为0.832（95%CI 0.785～0.926），预测患者术后复发的校正曲线趋近于理想曲线（P0.05）。ROC结果显示，列线图模型预测患者术后复发的灵敏度、特异度分别为83.30%、84.80%，AUC为0.878（95%CI 0.804～0.952，P0.05）。结论　通气管留置时间是中耳炎患者耳内镜术后复发的独立保护因素，伴慢性鼻窦炎、腺样体肥大、咽鼓管功能是其独立危险因素。基于上述影响因素建立的列线图模型可较好评估患者术后复发风险。

关键词:

中耳炎, 耳内镜手术, 术后复发, 影响因素, 风险预测模型, 列线图