感染与杓状软骨外展丧失可预测马喉成形术失败

文献信息

中文摘要

背景： 假体喉成形术（PL）是治疗马复发性喉神经病（RLN）最常见的手术方式。术后并发症可能影响结局，而品种和麻醉方式的影响仍不明确。
目的： 评估假体喉成形术（PL）术后3个月与手术结局相关的因素，重点关注术后并发症、麻醉方式和品种（尤其是伊比利亚巴洛克品种）。
研究设计： 多中心回顾性队列研究。
方法： 回顾了来自7家马医院、采用相同标准化手术技术的181匹马的病历。使用χ2检验或Fisher精确检验及Spearman相关性分析品种、麻醉类型、喉室声带切除术（VeC）方式和术后并发症等变量。采用两个以术者为随机效应的二项广义线性混合模型，评估术前/术中预测因素和术后预后因素。显著性水平p<0.05。手术成功定义为术后3个月无呼吸杂音和运动不耐受。
结果： 79.1%的病例获得手术成功。33.7%的马发生并发症，且与治疗成功呈负相关（比值比[OR] 0.003；95%置信区间[CI] 0.000-0.052；p<0.001）。杓状软骨外展严重丧失（18.2%）和手术部位感染（SSI；6.6%）是术后模型中仅有的与治疗成功几率降低独立相关的变量（分别为OR 0.011；95% CI 0.001-0.178；p=0.001和OR 0.046；95% CI 0.004-0.559；p=0.016）。品种与手术结局无关。
主要局限性： 回顾性多中心设计可能引入选择偏倚、临床实践差异和随访异质性。
结论： 杓状软骨外展严重丧失和SSI是手术失败最强的预测因素，凸显了精细技术、保持杓状软骨外展和严格感染控制对优化PL术后结局的重要性。

英文摘要

BACKGROUND: Prosthetic laryngoplasty (PL) is the most common surgical treatment for recurrent laryngeal neuropathy (RLN) in horses. Post-operative complications may compromise outcomes, and the influence of breed and anaesthetic approach remains unclear.
OBJECTIVES: To evaluate factors associated with surgical outcome at 3 months following PL, focusing on post-operative complications, anaesthetic modality and breed (particularly Iberian baroque breeds).
STUDY DESIGN: Multicentre retrospective cohort study.
METHODS: Medical records from 181 horses across 7 equine hospitals using the same standardised surgical technique were reviewed. Variables including breed, anaesthesia type, ventriculocordectomy (VeC) method and post-operative complications were analysed using χ2 or Fisher's exact tests and Spearman correlation. Two binomial generalised linear mixed models, with surgeon as a random effect, evaluated pre/intra-operative predictors and post-operative prognostic factors. Level of significance p < 0.05. Surgical success was defined as the absence of respiratory noise and exercise intolerance at 3 months.
RESULTS: Surgical success was achieved in 79.1% of cases. Complications occurred in 33.7% of horses and were negatively associated with treatment success (odds ratio [OR] 0.003; 95% confidence interval [CI] 0.000-0.052; p < 0.001). Major loss of arytenoid abduction (18.2%) and surgical site infection (SSI; 6.6%) were the only variables independently associated with reduced odds of treatment success in the post-operative model (OR 0.011; 95% CI 0.001-0.178; p = 0.001 and OR 0.046; 95% CI 0.004-0.559; p = 0.016, respectively). Breed was not associated with surgical outcome.
MAIN LIMITATIONS: The retrospective multicentre design may introduce selection bias, variability in clinical practice and heterogeneous follow-up.
CONCLUSIONS: Major loss of arytenoid abduction and SSI were the strongest predictors of failure, highlighting the importance of meticulous technique, preservation of arytenoid abduction and rigorous infection control to optimise outcomes after PL.