Prognostic factors of successful tympanoplasty in pediatric patients a cohort study 英文参考文献.docVIP

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Prognostic factors of successful tympanoplasty in pediatric patients a cohort study 英文参考文献.doc

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Prognostic factors of successful tympanoplasty in pediatric patients a cohort study 英文参考文献

Boronat-Echeverríaetal.BMCPediatrics2012,12:67 /1471-2431/12/1/67 RESEARCH ARTICLE OpenAccess Prognosticfactorsofsuccessfultympanoplastyin pediatricpatients:acohortstudy NuriaEsperanzaBoronat-Echeverría1,EsmeraldaReyes-García1,YolandaSevilla-Delgado1, HéctorAguirre-Mariscal1andJuanManuelMejía-Aranguré2* Abstract Background:Tympanoplastyinchildrenisacurrentandcontroversialtheme.Thesuccessoftympanoplasty traditionallyhasbeenmeasuredonlybythepost-operativeintegrityofthegraft.Yet,thereareothervariablesthat maybeusedtodeterminesuccess.Theobjectivesofthepresentworkweretoanalyzewhichfactorsarepredictive ofsuccessfultympanoplastyinpediatricpatientsandtoconstructandvalidateaprognosticindexthatcouldbe usedasatooltopredictthesuccessoftympanoplastyinchildren. Methods:Setting.DepartmentofPediatricOtorhinolaryngology,tertiary-carehospital,MexicoCity.Patients. Forty-eightpatients,whowereolderthatfiveyearsofage,hadpersistentperforationofthetympanicmembrane, andhadundergonetympanoplasty(January2005–June2008),werefollowedforayear.MainOutcomeMeasures. Thefactorstestedfortheirvalueaspredictorswerethefollowing:ageattimeofsurgery,stateofcontralateralear, previousadenoidectomy,causeofperforation,sizeofperforation,infectionatthetimeofsurgery,stateofmucosa, ageatfirstoccurrenceofperforation,presenceofcraniofacialdysmorphia,andsurgicaltechnique.Thesefactors werecomparedwiththecriterion,success,whichwasdefinedasattainingthreepositiveoutcomes:1)integrityof theimplantormembrane;2)minimumof10-dBgainintheauditorythresholdor,inthecaseofnormalhearing, conservationofsame;and3)air-filledspaceinthemiddleear.Thebestmodelwasobtainedthroughlogistic regressionanalysis;themodelwasvalidated. Results:Themostbalancedpredictionmodelwasthatinwhichthethreesuccesscriteriawereincluded,withage, surgicaltechnique,andinfectionatsurgerybeingexcludedasvariables.Theadditional12pediatriccasesusedin thevalidationhadaprobabilityofsuccess0.425(bestcut-offlevel);twopatients(17%)hadpoorevolution. Conclusions:Thisisthefirst