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视频辅助胸腔镜叶切除术中手术内决策的预测模型:优化高风险患者的胸腔排水位置
Oleg Pikin1, Andrey Ryabov1, Oleg Aleksandrov1
1Department of Thoracic Surgery, P. Hertsen Moscow Oncology Research Institute (MORI), Moscow, Russia.
Journal of thoracic disease
|October 24, 2024
概括
一种新的预后模型可以在视频辅助胸腔镜手术 (VATS) 叶切除术后识别患有紧张性肺胸高风险的患者. 这允许在手术期间放置额外的肺部排水,以防止肺部崩.
科学领域:
- 胸部外科手术 胸部外科手术
- 最少侵入性的手术
- 肺部医学 肺部医学
背景情况:
- 传统上,骨髓切除术后使用顶部和基底排水管,以确保完全排水腔.
- 胸腔镜技术的进步表明,单个胸腔管可以产生类似的临床结果.
- 然而,张力肺胸的风险需要进一步调查预防措施.
研究的目的:
- 开发一种预测模型,用于识别患有紧张性肺胸炎高风险的患者.
- 为了使外科手术期间进行干预,并进行额外的肺部排水.
- 为了减少视频辅助胸腔镜手术 (VATS) 后肺胸部发病率的发生.
主要方法:
- 使用注册数据 (2014-2022) 对418例VATS叶切除术病例进行了回顾性分析.
- 机器学习算法和数据合成用于患者选择的应用.
- 基于通过Akaike信息标准和引导验证识别的预后显著因素的二进制物流回归和名录创建.
主要成果:
- 紧张性肺胸部的整体发病率为4.53%.
- 确定的主要危险因素包括粘附,手术期间的肺部 suturing,融化间叶裂,扩大的肺内淋巴结和COPD (P<0.001).
- 开发的名图表显示出高预测性能 (C指数=0.957),得分为26,表明95%的风险.
结论:
- 一个经过验证的nomogram有效地预测紧张性肺胸切除术后的紧张性肺胸风险.
- 识别高风险个体可以进行有针对性的手术内干预.
- 积极地放置额外的肺部排水可以减轻术后肺部缩.
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