喉镜评分预测支撑喉镜手术暴露的临床意义

doi:10.6040/j.issn.1673-3770.0.2019.303

摘要/Abstract

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

宋颖,潘忠,傅敏仪. 喉镜评分预测支撑喉镜手术暴露的临床意义[J]. 山东大学耳鼻喉眼学报, 2019, 33(6): 81-84.

SONG Ying,PAN Zhong,FU Minyi. Clinical significance of laryngoscope scoring system in predicting the laryngeal exposure[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(6): 81-84.

参考文献

[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.

相关文章 15

[1]	张国民,王茂华,高松,吴文斌,虞幼军. 持续灌流模式耳内镜下粘连性中耳炎手术疗效分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 16-19.
[2]	肖俊华,潘庆春,晋舒. 基于全球疾病负担数据库分析职业硫酸暴露下喉癌患者的死亡趋势[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 55-61.
[3]	徐娟,崔彪,黄建平,陈以标,施建飞,王燕雯,刘赞华,张剑伟. 电子喉镜评估老年肺部感染患者的吞咽功能[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 74-79.
[4]	卢朝阳, 翟兆雪, 王慧康, 邵丽婷, 张宇. 新冠肺炎治疗引发糖尿病酮症酸中毒合并鼻眶脑型毛霉菌病1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2026, 40(1): 90-94.
[5]	高娟娟,许嘉,陈雯婧,梁思超,郭振平,陈俊言,郭翔,伊海金. 保留面神经功能的面神经鞘瘤次全切除手术治疗[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 8-16.
[6]	刘玉柱,陈尧,苑铁君,李春森,李波. 喉纤维肉瘤1例并相关文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 133-137.
[7]	陈涛,姜洋,李莹. SMILE矫正PRK术后屈光回退1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 148-153.
[8]	黄旗,邓旭雯,王佩佩,陈烨群,古学军. 基于EyeSi手术模拟器评估眼科医师白内障手术水平[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 83-88.
[9]	王再兴,唐志元,李定波,石照辉,曾宪海,张秋航. 鼻咽癌放疗后肿瘤复发及颅底骨坏死引起颈内动脉破裂的治疗方案[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 49-58.
[10]	孙芳,谢楚波,邱前辉. 营养指标对鼻咽癌放射性颅底坏死患者创面修复影响的回顾性分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 59-68.
[11]	姜知临,朱瑞楷,邱前辉. 基于影像学对咽旁颈内动脉走行的观察与分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 69-76.
[12]	吴家荣,邱前辉. 颅底筋膜组织在早期复发性鼻咽癌内镜手术中的临床意义[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 108-113.
[13]	郭荣昌,刘晴航,王洪增,孙树军. 巨大鼻眼贯通、颅底嵌顿异物损伤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 135-141.
[14]	张中华,王辉,王俊鑫,张美玲,张建,张恩东,潘新良. 腋窝入路腔镜手术和传统颈部开放手术治疗T1甲状腺癌的安全性和有效性对比研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 161-167.
[15]	倪凌达,唐旭兰,孟丽丽,周慧群,苏开明. 电子鼻咽喉镜中I-scan各模式与白光模式的应用比较[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 19-25.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed