支撑喉镜手术中需压喉暴露声门的相关因素分析

The related factors of essential pressing larynx to exposure glottis under retaining laryngoscope surgery

目的:探索支撑喉镜下需压喉暴露声门的相关因素,为术前评估手术难度提供依据。方法:选取60例支撑喉镜手术患者,采集术前可能影响声门区暴露的相关临床数据,包括性别、年龄、体重、颏甲距离、开口状态、Mallampati分级、打鼾病史,术中记录暴露声带时是否需要压喉的情况。结果:术中支撑喉镜下需要压喉暴露声门者占45%。需要压喉暴露声门者的年龄、体重及BMI明显大于不需要压喉就能显露者(P<0.05)。男性患者中需要压喉显露者的颏甲距离小于不需压喉者(P<0.01),身高/颏甲距离比值明显大于不需压喉者(P<0.01)。对以上有明显差别的指标再通过ROC曲线拟合计算其临界值。全部患者中,如果年龄>31岁、体重>59kg或BMI>23.4,术中声门暴露需要压喉的可能性明显增加(均P<0.05)。男性患者中颏甲距离<8.5cm、身高/颏甲距离比值>20.4或年龄>45岁,术中需要压喉暴露声门可能性明显增加(均P<0.05)。结论:一部分患者在进行支撑喉镜声门手术时需压喉以辅助暴露声门。患者的年龄、体重、BMI,男性患者中颏甲距离、身高/颏甲距离比值可以在一定程度上预测术中是否需喉外按压辅助暴露声门,为术前评估支撑镜喉显微手术的难度提供参考。

Objective：To investigate the related factors of essentiai pressing larynx to expose glottis under vo cal cord surgery with retaining laryngoscope, for prediction of the surgery difficulty. Methyl： Sixty patients were involved in this study. All of them had been operated under the retaining laryngoscope. The potential related fac- tors including gender, age, weight, thyroid-chin distance, length of mouth opening, Mallampati （MP） grading, snoring history, were measured and documented. Result： The occurrence of essential pressing larynx during the surgery was recorded. The ratio of essential press larynx was 45%. For all patients, the data showed that the age, body weight and body mass index of pressing larynx patients were significantly greater than normal exposure vocal patients（P〈0.05）. For male patients, the thyroid-chin distance（P〈0.01） of patients with pressing larynx were significantly less than others without pressing larynx, and height/thyroid-chin distance ratio（P〈0.01） were significantly greater than others without pressing larynx. Through the calculation of ROC curve fitting, the proba- bility of press larynx increased when the age was over 31 years（P〈0.01）, the body weight were more than 59 kg （P〈.0.01） and body mass index were greater than 23.4（P〈0.05） in all patients. For male patients, The proba- bility of press larynx increased when the thyroid-chin distance was less than 8.5 cm（P〈0.05）, height/thyroid- mandible distance ration was greater than 20.4（P〈0.05） or the age was over 45 years（P〈0.01）. Cenelusien： Some patients need to press the larynx to exposure the glottis during the retaining laryngoscope surgery. Through age, weight, body mass index in the patients, and the thyroid-chin distance and height/thyroid-mental distance ra- tio especially in male patients, we can predict the glottis exposure difficulty in intuhation or vocal operation with or without pressing larynx.