听神经瘤患者术后听力保留的影响因素分析及其预测模型构建

Analysis of Influencing Factors of Postoperative Hearing Preservation in Patients with Acoustic Neuroma and Construction of Predictive Model

目的分析听神经瘤患者术后听力保留的影响因素,并构建风险预测模型。方法选取2017年5月~2022年5月进行手术治疗且术前有残余听力的84例听神经瘤患者为研究对象,统计患者性别、年龄、肿瘤大小、术中是否行ABR和ECochG联合监测、内听道是否扩大、肿瘤和神经是否粘连、内听道脑脊液充盈程度、术前听力分级等资料,并进行相关影响因素分析、多因素分析和预测模型的构建。结果84例术前有实用残余听力者中,术后1年仍保留实用听力者共23例,总体听力保留率约为27.38%(23/84)。相关影响因素分析得知,性别、年龄、术前听力分级与术后听力保留无关(P>0.05),而肿瘤大小、术中是否行ABR和ECochG联合监测、内听道是否扩大、肿瘤和神经是否粘连、内听道脑脊液充盈程度与术后听力保留均有关(均为P<0.05)。Logistic多因素结果显示,肿瘤体积大、内听道扩大、肿瘤和神经粘连是听神经瘤患者术后听力保留的危险因素;术中行ABR和EcochG联合监测、内听道脑脊液充盈程度高是听神经瘤患者术后听力保留的保护性因素(均为P<0.05)。预测模型的公式为In(P/1-P)=-0.202+3.875×肿瘤大小-4.019×术中是否行ABR和EcochG联合监测+3.122×内听道是否扩大+2.383×肿瘤和神经是否粘连-3.293×内听道脑脊液充盈程度。H-L检验结果显示该模型拟合优度好(χ^(2)=0.583,P=1.000);ROC分析结果显示该模型的曲线下面积为0.958,最佳截断值为0.825,灵敏度为83.6%,特异性为91.3%。结论术中行ABR和EcochG联合监测、内听道脑脊液充盈程度高是听神经瘤患者术后听力保留的保护性因素,肿瘤体积大、内听道扩大、肿瘤和神经粘连是听神经瘤患者术后听力保留的危险因素。

Objective To analyze the influencing factors of postoperative hearing preservation in patients with acoustic neuroma and construct a risk prediction model.Methods A total of 84 patients with acoustic neuroma who underwent surgical treatment in our hospital from May 2017 to May 2022 and who had preoperative residual hearing were selected as research subjects.Gender,age,tumor size,whether ABR and ECochG joint monitoring was performed during the operation,the enlargement status of the internal auditory canal,the status of tumor and nerve adhesion,the degree of cerebrospinal fluid filling of the internal auditory canal,preoperative hearing classification were recorded.Analysis of relevant influencing factors and multi-factor analysis were performed,and predictive models were constructed.Results Among 84 patients,23 patients had hearing retention after one year of surgery,the total retention rate was about 27.38%(23/84).Analysis of the relevant influencing factors showed that gender,age,and preoperative hearing classification were not correlated with postoperative hearing preservation(P>0.05).But the size of the tumor,whether ABR and ECochG joint monitoring was performed during the operation,whether the internal auditory canal was enlarged,whether the tumor and nerves were adhered,and the degree of cerebrospinal fluid filling of the internal auditory canal were all correlated with postoperative hearing preservation(P<0.05).Logistic multivariate results showed that large tumor size,the enlargement of the internal auditory canal,adhesion between the tumor and nerves were risk factors for postoperative hearing preservation in patients with acoustic neuroma.The combination of ABR and EcochG monitoring during surgery,and the degree of filling of the cerebrospinal fluid in the in internal auditory canal were protective factors for postoperative hearing preservation in patients with acoustic neuroma(P<0.05).The formula for the prediction model was In(P/1-P)=-0.202+3.875×Tumor size(small size=1,large size=2)-0.4.019×Whether ABR and ECochG joint monitoring was performed during the operation(Yes=2,No=1)+3.122×Whether the internal auditory canal was enlarged(Yes=2,No=1)+2.383×Whether the tumor and nerves were adhered(Yes=2,No=1)-3.293×The degree of cerebrospinal fluid filling of the internal auditory canal(Partial filling=1,Complete filling=2).The H-L test results showed that the model had a good fit(χ^(2)=0.583,P=1.000).The ROC analysis results showed that the area under the curve of the model was 0.958,with the best cut-off value being 0.825.The sensitivity was 83.6%,and the specificity was 91.3%.Conclusion The combination of ABR and EcochG monitoring during surgery,the degree of filling of the cerebrospinal fluid in the internal auditory canal are protective factors for postoperative hearing preservation in patients with acoustic neuroma.Large tumor size,the enlargement of the internal auditory canal,and adhesion between the tumor and nerves are risk factors for postoperative hearing preservation in patients with acoustic neuroma.