山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (6): 81-84.doi: 10.6040/j.issn.1673-3770.0.2019.303

• • 上一篇    

喉镜评分预测支撑喉镜手术暴露的临床意义

宋颖,潘忠,傅敏仪   

  1. 中山大学附属中山医院 中山市人民医院耳鼻咽喉头颈外科, 广东 中山 528400
  • 发布日期:2019-12-23

Clinical significance of laryngoscope scoring system in predicting the laryngeal exposure

SONG Ying,PAN Zhong,FU Minyi   

  1. Department of Otorhinolaryngology Head and Neck Surgery, Zhongshan Hospital, Zhongshan Peoples Hospital Affiliated to Sun Yat-sen University, Zhongshan 528400, Guangdong, China
  • Published:2019-12-23

摘要: 目的 研究喉镜评分系统对于支撑喉镜手术中声门暴露困难程度的预测作用。 方法 应用双盲试验方法,测试员用喉镜评分系统对支撑喉镜手术患者进行术前测量及评分,术者在术中对患者声门暴露困难程度进行评估分级,收集数据后统计两者是否具有相关性,及分析主要相关因素。 结果 当患者术前喉镜评分为6分及以下时,术中82.8%的概率出现可接受喉暴露,17.2%的可能出现困难喉暴露。当患者术前喉镜评分超过6分时,术中100%的概率会出现困难喉暴露。困难喉暴露预测系统(>6分)的灵敏度、特异度、误诊率、漏诊率分别为100%(20/20)、82.8%(48/58)、0%(0/20)、17.2%(10/58)。有统计学意义的变量为:开口牙裂距离、甲状软骨角-颏下距离、颈部伸展角度、体质量指数、小颌畸形。 结论 利用简易可行的术前支撑喉镜评分系统,将6分作为困难喉暴露与可接受喉暴露的分界,准确度较高,在临床上简单易操作,具有一定的实用性。

关键词: 喉镜, 手术, 暴露

Abstract: Objective To investigate the predictive effect of the laryngoscopy scoring system on cases of difficult glottic exposure during laryngoscopy. Methods This was a double-blind study, in which the laryngoscopy scoring system was used to preoperatively examine and score patients who were undergoing laryngoscopy. The surgeon assessed and graded the difficulty in glottis exposure during the operation, to assess whether it was relevant and could analyze the associated factors. Results When the patient had a preoperative laryngoscope score of ≤6, an acceptable laryngeal exposure was observed at an 82.8% probability, while a difficult laryngeal exposure was found at 17.2%. When the patient's preoperative laryngoscopy score exceeded 6, a 100% probability of surgery would lead to difficult laryngeal exposure. The sensitivity, specificity, misdiagnosis, and missed-diagnosis rates of the difficult laryngeal exposure prediction system(>6 points)were 100%(20/20), 82.8%(48/58), 0%(0/20), and 17.2%(10/58), respectively. Statistically significant variables included open cleavage distance, thyroid cartilage angle-underarm distance, neck extension angle, body mass index, and small jaw deformity. Conclusion Using the simple and feasible preoperative support laryngoscopy scoring system, a threshold of 6 points was used to distinguish cases with difficult laryngeal exposure from those with acceptable laryngeal exposure, with relatively high accuracy. Furthermore, this scoring system proved to be simple and easy to operate in clinical practice and could be certainly considered practicable.

Key words: Laryngoscopy, Sugery, Exposure

中图分类号: 

  • R767.91
[1] Hillel AT, Ochsner MC, Johns MM 3rd, et al. A cost and time analysis of laryngology procedures in the endoscopy suite versus the operating room[J]. Laryngoscope, 2016, 126(6): 1385-1389. doi:10.1002/lary.25653.
[2] Hsiung MW, Pai L, Kang BH, et al. Clinical predictors of difficult laryngeal exposure[J]. Laryngoscope, 2004, 114(2): 358-363. doi:10.1097/00005537-200402000-00033.
[3] Piazza C, Mangili S, Bon FD, et al. Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: the Laryngoscore[J]. Laryngoscope, 2014, 124(11): 2561-2567. doi:10.1002/lary.24803.
[4] Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study[J]. Can Anaesth Soc J, 1985, 32(4): 429-434. doi:10.1007/bf03011357.
[5] 马玲国, 郑朝攀, 周敬淳, 等. CO2激光治疗声门型喉癌远期疗效分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(5): 98-100, 105. doi: 10.6040 /j.issn.1673-3770.0.2015.426. MA Lingguo, ZHENG Chaopan, ZHOU Jingchun, et al. Long-term curative effect of CO2 laser surgery for glottic laryngeal carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(5): 98-100, 105. doi: 10.6040 /j.issn.1673-3770.0.2015.426.
[6] 李文明, 魏东敏, 钱晔, 等. 支撑喉镜下CO2激光治疗喉癌的疗效分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 13-17. doi:10.6040/j.issn.1673-3770.1.2018.025. LI Wenming,WEI Dongmin,QIAN Ye,et al. Evaluate the curative effect of CO2 laser in treatment of laryngeal carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 13-17. doi:10.6040/j.issn.1673-3770.1.2018.025.
[7] Paul RR, Varghese AM, Mathew J, et al. Difficult laryngeal exposure in microlaryngoscopy: can it be predicted preoperatively?[J]. Indian J Otolaryngol Head Neck Surg, 2016, 68(1): 65-70. doi:10.1007/s12070-015-0913-9.
[8] Piazza C, Paderno A, Grazioli P, et al. Laryngeal exposure and margin status in glottic cancer treated by transoral laser microsurgery[J]. Laryngoscope, 2018, 128(5): 1146-1151. doi:10.1002/lary.26861.
[9] Ohno S, Hirano S, Tateya I, et al. Management of vocal fold lesions in difficult laryngeal exposure patients in phonomicrosurgery[J]. Auris Nasus Larynx, 2011, 38(3): 373-380. doi:10.1016/j.anl.2010.10.006.
[10] 黎景佳, 陈伟雄, 朱肇峰, 等. 支撑喉镜显微手术声门区暴露困难相关因素的前瞻性研究[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(7): 520-523. doi:10.13201/j.issn.1001-1781.2017.07.007. LI Jingjia,CHEN Weixiong,ZHU Zhaofeng,et al. Prospective study of riskfactors of difficult laryngeal exposure in suspension laryngoscopy[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2017, 31(7): 520-523. doi:10.13201/j.issn.1001-1781.2017.07.007.
[11] 张宏强,田素景,杨国庆,等. 支撑喉镜下声门暴露困难综合预测系统的建立[J]. 临床耳鼻咽喉头颈外科杂志,2015,29(16):1471-1473. doi:10. 13201/j.jssn.1001-1781.2015.16.015. ZHANG Hongqiang,TIAN Sujing,YANG Guoqing,et al. Study of building up a comprehensive system for predicting difficult laryngeal exposure under suspension laryngoscopy[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015,29(16):1471-1473.doi:10. 13201/j.jssn.1001-1781.2015.16.015.
[12] 王吉选,胡艳红,王东海,等. 支撑喉镜下声门暴露困难相关因素分析[J]. 临床耳鼻咽喉头颈外科杂志,2015,29(17):1519-1521. doi:10. 13201/j.jssn.1001-1781.2015.17.007. WANG Jixuan,HU Yanhong,WANG Donghai,et al.The related factors analysis of difficult laryngeal exposure under retaining laryngoscope[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015,29(17):1519-1521. doi:10. 13201/j.jssn.1001-1781.2015.17.007.
[13] 黄晨,莫江. 影响显微支撑喉镜下声门暴露的相关因素研究[J]. 中国耳鼻咽喉颅底外科杂志,2016,22(4):317-322. doi:10. 11798/j.jssn.1007-1520.201604015. HUANG Chen,MO Jiang.Study on affect factors related to laryngeal exposure in self-retaining microscopic surgery[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery,2016,22(4):317-322.doi:10. 11798/j.jssn.1007-1520.201604015.
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