更好地利用患者术前信息预测腭咽成形术结局的意义：一项前瞻性队列研究。
The significance of better utilization of patients' preoperative information in predicting outcomes of velopharyngeal surgery: a prospective cohort study.
机构信息
Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China.
Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
出版信息
J Clin Sleep Med. 2022 Mar 1;18(3):843-850. doi: 10.5664/jcsm.9734.
STUDY OBJECTIVES
To compare the efficiency of a TCM scoring system that includes 3 independent predictors obtained by physical examination, computed tomography, and polysomnography with the standard Friedman staging system that includes only physical examination variables for predicting surgical outcomes in patients with obstructive sleep apnea syndrome who undergo velopharyngeal surgery.
METHODS
This prospective study was carried out in 265 patients with obstructive sleep apnea syndrome who underwent velopharyngeal surgery. All these patients were re-examined with polysomnography for evaluation of surgical outcomes at least 3 months after surgery. The efficacies in the surgical outcome prediction of 2 systems were calculated and compared.
RESULTS
The overall response rate and cure rate was 63.8% (169/265) and 22.3% (59/265), respectively. There were 32 patients with Friedman stage I, with a response rate and cure rate of 81.3% (26/32) and 28.1% (9/32), respectively, and 70 patients with TCM scores of < 14 with a response rate and cure rate of 91.4% (64/70) and 42.9% (30/70), respectively. Friedman stage and TCM grade were the only 2 factors independently predictive of surgical response ( < .05, odds ratio value = 0.642 and 0.382). The receiver operating characteristic curve analysis for surgical response showed that the area under the curve value was 0.600 for Friedman stage, which was significantly lower than that for TCM grade, 0.718 ( = .005). Apnea-hypopnea index and TCM grade were the only 2 factors independently predictive of surgical cure ( < .05, odds ratio value = 0.981 and 0.465).
CONCLUSIONS
Compared with the Friedman staging system, the TCM scoring system was more efficient in selecting proper candidates for velopharyngeal surgery. The main reason may be its better utilization of patients' preoperative information, especially the inclusion of physiological factors.
CLINICAL TRIAL REGISTRATION
Registry: Chinese Clinical Trials Register; Name: Clinical Phenotypes and Precise Treatment of Adult OSA (Obstructive Sleep Apnea): A Multicenter Study; URL: http://www.ChiCTR.org.cn/showproj.aspx?proj=21189; Identifier: ChiCTR-ONC-17013132.
CITATION
Zhang J, Cao X, Yin G, et al. The significance of better utilization of patients' preoperative information in predicting outcomes of velopharyngeal surgery: a prospective cohort study. . 2022;18(3):843-850.
研究目的
比较一种中医评分系统和标准的 Friedman 分期系统在预测阻塞性睡眠呼吸暂停综合征（OSA）患者接受悬雍垂腭咽成形术（UPPP）后的手术效果方面的效率，前者包含 3 个通过体格检查、计算机断层扫描和多导睡眠图获得的独立预测因子，而后者仅包含体格检查变量。
方法
这是一项前瞻性研究，共纳入 265 例接受 UPPP 的 OSA 患者。所有患者术后至少 3 个月均通过多导睡眠图复查以评估手术效果。计算并比较了 2 种系统在手术效果预测方面的效能。
结果
总体有效率和治愈率分别为 63.8%（169/265）和 22.3%（59/265）。Friedman 分期 I 期患者 32 例，有效率和治愈率分别为 81.3%（26/32）和 28.1%（9/32）；中医评分<14 分的患者 70 例，有效率和治愈率分别为 91.4%（64/70）和 42.9%（30/70）。Friedman 分期和中医分级是唯一能独立预测手术反应的 2 个因素（均 < 0.05，比值比分别为 0.642 和 0.382）。手术反应的受试者工作特征曲线分析显示，Friedman 分期的曲线下面积为 0.600，明显低于中医分级的 0.718（ = 0.005）。呼吸暂停低通气指数和中医分级是唯一能独立预测手术治愈率的 2 个因素（均 < 0.05，比值比分别为 0.981 和 0.465）。
结论
与 Friedman 分期系统相比，中医评分系统在选择合适的悬雍垂腭咽成形术患者方面更有效。主要原因可能是其更好地利用了患者的术前信息，特别是纳入了生理因素。
临床试验注册
注册机构：中国临床试验注册中心；名称：成人 OSA 的临床表型和精准治疗：多中心研究；网址：http://www.ChiCTR.org.cn/showproj.aspx?proj=21189；标识符：ChiCTR-ONC-17013132。
引文
Zhang J, Cao X, Yin G, et al. The significance of better utilization of patients' preoperative information in predicting outcomes of velopharyngeal surgery: a prospective cohort study.. 2022;18(3):843-850.
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