超声评价甲状腺癌术前声带麻痹的研究

Ultrasonic evaluation of vocal cord paralysis before thyroid carcinoma surgery

目的评价超声检测声带运动在诊断甲状腺癌术前声带麻痹中的临床价值。方法选取经穿刺或手术病理检查证实为甲状腺癌且出现声音嘶哑的患者35例,分别行声带区超声检查和喉镜检查,通过对声带及杓状软骨被动和主动运动的超声观察,对声带进行1~3级分级(1级为声带运动正常,2级以上为声带麻痹)。喉镜评价声带运动采取类似标准。比较两种方法之间的差异,并以喉镜结果为金标准,绘制超声诊断声带麻痹的受试者工作特征(ROC)曲线,计算曲线下面积、敏感性、特异性、阳性预测值、阴性预测值、约登指数及诊断符合率。结果 35例患者中,喉镜与超声检查声带活动分级均为:1级5例,2级17例,3级13例,两种检查方法比较差异无统计学意义(χ2=0.000,P=1.000)。超声诊断声带麻痹的曲线下面积为0.883(P=0.007),敏感性为96.7%,特异性为80.0%,阳性预测值为96.7%,阴性预测值为80.0%,约登指数为0.77,诊断符合率为94.3%。结论超声检测声带活动对评价声带麻痹具有较高的诊断价值,可用于甲状腺癌侵犯喉返神经的术前评估。

Objective To evaluate the clinical value of vocal cord movement in the diagnosis of vocal cord paralysis before thyroid carcinoma surgery by ultrasonography.Methods Thirty-five patients with thyroid carcinoma accompanied by hoarseness were confirmed by biopsy or surgery were enrolled in this study.All the patients were examined by ultrasonography and laryngoscope.The passive and active movements of vocal cord and arytenoid cartilage were observed by ultrasonography.The movements were categorized into grades 1-3（grade 1 was regarded as normal,more than grade 2 as paralysis）.The evaluation criterion for laryngoscope was similar.The difference between the two methods was statistically analyzed and the laryngoscope results was used as the gold standard,the ROC curve for ultrasonogrpahy in diagnosis of vocal cord paralysis was drawn,and the area under curve（AUC）,sensitivity,specificity,positive predictive value,negative positive value,Youden index and diagnose accordance rate were calculated.Results In 35 patients,the grading of vocal cord movements by ultrasonography and laryngoscope was the same：5 cases were grade 1,17 cases were grade 2 and 13 cases were grade 3,there was no significant difference between two methods（χ2=0.000,P=1.000）.AUC for ultrasonography diagnosis of vocal cord paralysis was 0.883（P=0.007）,the sensitivity,specificity,positive predictive rate,negative predictive rate,Youden index and diagnose accordance rate were96.7%,80.0%,96.7%,80.0%,0.77 and 94.3%,respectively.Conclusion Ultrasonography has a high value in the diagnosis of vocal cord paralysis and can be used for the peroperative evaluation of thyroid carcinoma invasion of recurrent laryngeal nerve.