儿童长期气管造口术患者造口周围气管病理分类建议
A proposed classification of peristomal tracheal pathology in children with long-term tracheostomies.
文献信息
| PMID | 42721664 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Oshri Wasserzug |
| 作者单位 | Department of Otolaryngology - Head and Neck and Maxillofacial Surgery, Division of Pediatric Otolaryngology, "Dana" Children's Hospital, Tel-Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: droshriw@gmail.com. |
| 期刊 | International journal of pediatric otorhinolaryngology |
| SCI 分区 | Q2 |
| IF | 1.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 目前尚无用于预测拔管以及比较和选择造口周围气管病理各种治疗方式的分类模块。我们的目的是提出一种适用于临床实践的分类，并评估其观察者间和观察者内信度。
方法： 本回顾性研究纳入了28例长期气管造口术儿童的硬质气管镜检查视频。另纳入10个重复视频。随后，来自4个转诊中心的6名儿科耳鼻喉科医生分别观看这38个视频，并使用所提出的评分系统进行评分。评分包括5个领域：1. 总体阻塞估计，2. 肉芽组织受累，3. 气管狭窄受累，4. 气管软化，5. 侧壁受累。
结果： 评分者之间一致性的Kendall系数对于阻塞百分比估计（条件1）非常好（0.847，95% CI：0.787-0.901），对于肉芽组织受累（条件2）为中等（0.575，95% CI：0.514-0.647），对于气管狭窄受累、气管软化成分受累和侧壁受累（条件3、4和5）为一般。条件1、2和5的观察者内一致性非常好（分别为0.866、0.857和0.805），条件3为好（0.704），条件4仅为中等（0.576）。
结论： 对于总体气道阻塞，一致性极好；对于肉芽组织受累，观察者间为中等，但观察者内非常好。对于气管软化、气管狭窄和侧壁受累，一致性仅为一般，这些领域需要改进。需要前瞻性结局研究来检验其预测价值。
证据等级： 2b。
英文摘要
OBJECTIVE: There is currently no classification module for predicting decannulation and comparing and choosing among various treatment modalities for peristomal tracheal pathologies. Our aim is to propose such a classification for application in clinical practice and to evaluate its interobserver and intraobserver reliability.
METHODS: Videos of 28 rigid tracheal endoscopies of children with long-standing tracheostomies were included in this retrospective study. Ten repeat videos were also included. The 38 videos were then viewed individually by 6 pediatric otolaryngologists from 4 referral centers who scored them with the proposed scoring system. There were 5 scoring domains: 1. Estimate of overall obstruction, 2. Granulation tissue involvement, 3. Tracheal stenosis involvement, 4. Tracheomalacia, and 5. Lateral wall involvement.
RESULTS: Kendall's coefficient for concordance between raters was very good (0.847, 95% CI: 0.787-0.901) for Percentage of obstruction estimate (condition 1), moderate (0.575, 95% CI: 0.514-0.647) for Granulation tissue involvement (condition 2) and fair for Tracheal stenosis involvement, Tracheomalacia component involvement and Lateral wall involvement (conditions 3, 4, and 5). The intraobserver agreement for conditions 1, 2 and 5 was very good (0.866, 0.857 and 0.805, respectively), good for condition 3 (0.704) and only moderate for condition 4 (0.576).
CONCLUSION: Agreement was excellent for overall airway obstruction and, for granulation tissue involvement, moderate between observers but very good within observers. Agreement for tracheomalacia, tracheal stenosis and lateral wall involvement was only fair, and these domains need refinement. Prospective outcome studies are required to test predictive value.
LEVEL OF EVIDENCE: 2b.