中国耳鼻咽喉头颈外科2025，Vol.32Issue(11)：724-728,5.DOI:10.16066/j.1672-7002.2025.11.009
硬质支气管镜下气管支气管异物取出术后行二次纤维支气管镜检查的危险因素分析及预测模型构建
Risk factor analysis and prediction model construction of secondary fiberoptic bronchoscopy after rigid bronchoscope tracheobronchial foreign body removal surgery
摘要
Abstract
OBJECTIVE To analyse risk factors for secondary fiberoptic bronchoscopy in pediatric patients with tracheobronchial foreign bodies undergoing rigid bronchoscope removal,where imaging studies indicate suspected residual foreign bodies;to construct a risk prediction model and evaluate its predictive efficacy.METHODS A retrospective analysis was conducted on the clinical records of 222 pediatric patients with tracheobronchial foreign bodies admitted to the Department of Otorhinolaryngology at Shanxi Provincial Children's Hospital(Shanxi Provincial Maternal and Child Health Hospital)between January 2022 and April 2025.Patients requiring secondary fiberoptic bronchoscopy due to suspected residual foreign bodies on postoperative imaging were assigned to the secondary surgery group,while those with no residual foreign bodies on imaging were assigned to the primary surgery group.General clinical characteristics and surgical outcomes were compared between the two groups.A binary multivariate logistic regression model was employed to analyse risk factors influencing the need for secondary fiberoptic bronchoscopy following rigid bronchoscope foreign body removal in pediatric patients.Based on the identified risk factors,a risk prediction model was constructed,and its model fit and predictive efficacy were evaluated.RESULTS This study included 222 pediatric patients with tracheobronchial foreign bodies,of whom 19 underwent secondary fiberoptic bronchoscopy following foreign body removal,yielding a secondary procedure rate of 8.56%(19/222).Bivariate multivariate logistic regression analysis indicated that patient age and operator experience were not risk factors for secondary surgery.Conversely,male gender,foreign body location in the distal main bronchus or within the secondary bronchi,foreign body fragility following forceps grasping,prolonged retention time,and multiple complications were identified as independent risk factors for secondary surgery.Model validation revealed good fit between the calibration curve and the ideal curve(Hosmer-Lemeshow test χ²=13.868,P=0.085).External validation using receiver operating characteristic(ROC)curves demonstrated an area under the curve(AUC)of 0.9152(95%CI=0.839-0.991,P<0.05)for predicting residual foreign bodies.Sensitivity was 84.21%,specificity 94.58%,and the Youden index 0.788.CONCLUSION The location of tracheobronchial foreign bodies in the distal main bronchus to the second-level bronchi,the fragility of foreign bodies when grasped by forceps,prolonged retention time,multiple complications,and male gender are independent risk factors for requiring a second fiberoptic bronchoscopy following bronchial foreign body removal.The risk prediction model developed in this study demonstrates good predictive capability for the need for secondary fiberoptic bronchoscopy following rigid bronchoscope foreign body removal,where imaging studies indicate bronchial obstruction shadows.关键词
儿童/气管/支气管/异物/危险因素/预测模型Key words
Child/Trachea/Bronchi/Foreign Bodies/Risk Factors/prediction model引用本文复制引用
牛慧慧,徐晶,程清峰,马玉强,王勤学..硬质支气管镜下气管支气管异物取出术后行二次纤维支气管镜检查的危险因素分析及预测模型构建[J].中国耳鼻咽喉头颈外科,2025,32(11):724-728,5.基金项目
山西省基础研究计划(自由探索类青年科学研究项目)(202403021212195) （自由探索类青年科学研究项目）
