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  

Prospective study of riskfactors of difficult laryngeal exposure in suspension laryngoscopy

作　　者：黎景佳[1] 陈伟雄[1] 朱肇峰[1] 张剑利[1] 何发尧[1] 王跃建[1] 

机构地区：[1]佛山市第一人民医院耳鼻咽喉头颈外科,广东佛山528000

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第7期520-523,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：广东省科技计划项目公益研究与能力建设专项(No:2014A020212075);广东省自然科学基金自由申请项目(No:2016A030313245)

摘　　要：目的:探讨影响支撑喉镜显微手术声门区暴露困难的相关因素,为术前评估提供参考。方法:采取前瞻性研究设计的方法,选取90例因声带疾病(包括声带息肉、声带小结、声带囊肿、喉乳头状瘤等)接受支撑喉镜显微手术的患者,术前采集可能影响声门区暴露的相关临床数据,术中记录患者声门区暴露情况,建立数据库,统计分析影响支撑喉镜显微手术声门区暴露困难的相关因素。结果:单因素分析显示年龄(P=0.038)、Cormack-Lehane评分(P=0.007)、最大张口间距(P=0.007)、过伸位颏舌距(P=0.033)、过伸位颏甲距(P=0.014)、过伸位垂直颏甲距(P=0.042)、过伸位颏胸距(P=0.01)和颈部屈伸度(P=0.003)与声门区暴露困难相关;Logistic多元线性回归分析显示,Cormack-Lehane评分(P=0.003)、最大张口间距(P=0.001)和颈部屈伸度(P=0.002)是与声门区暴露困难相关的独立危险因素。结论:患者术前间接喉镜检查Cormack-Lehane评分、最大张口间距和颈部屈伸度在一定程度上可预测支撑喉镜显微手术声门区暴露情况,术前可结合这些指标加强评估、防范和减少手术并发症的发生。Objective ：The aim of this study was to demonstrate the risk factors which affect the exposure of glottis in suspension laryngoscopy. Method：We performed a prospective study about 90 cases of vocal cord lesions underwent microlaryngosurgery（including polyps, vocal nodules, cyst and papilloma）. Then we recorded the clinical data related to glottic exposure, both preoperatively and intraoperatively. Result： Univariate analysis showed that parameters like age（P=0. 038）, Cormack-Lehane score（P=0.007）,maximuminterincisors gap（P= 0. 007）, hyold-mental distance（HMD） in full extension（P= 0. 033）, thyroid-mental distance（TMD） in full extension（P= 0. 014）, vertical thyroid-mental distance（VTMD） in full extension（P=0. 042）, sternum-mental distance（SMD） in full extension（P = 0.01） and degree of neck flexion-extension （P = 0. 003 ） were related to intraoperative difficult exposure of the glottic area. In logistic regression analysis, Cormack-Lehane score（P= 0. 003）, maximuminterincisots gap（P= 0. 001） and degree of neck flexion-extension（P= 0. 002） were significantly risk factors of difficult la- ryngealexposure. Conclusion ： Combination of Cormack-Lehane score, maximuminterincisors gap and degree of neck flexion-extensionmay help to predict the difficult laryngealexposure, so we should evaluate patients before operations of suspension laryngoscopy to decrease the surgical complication.

关 键 词：喉镜 外科手术 声门 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]