内镜检查在预测声门暴露困难中的应用

Application of endoscopy in predicting the difficulty of glottis exposure

目的探讨内镜检查在预测声门暴露困难中的应用价值,为术前评估提供参考.方法将2017年1月~ 2018年10月就诊并需要择期行支撑喉镜喉显微手术的喉部病变患者70例纳入研究,根据声门暴露情况进行分级,将Ⅲ度和Ⅳ度为声门暴露困难组,Ⅰ度和Ⅱ度为对照组.观察声门暴露困难组和对照组患者的舌平面评分和会厌上缘评分,观察两组患者的Friedman舌根分级.对舌平面评分、会厌上缘评分、Friedman舌根分级和声门暴露困难的相关性进行分析.结果 70例患者中,有6例患者术中属声门暴露困难,发生率为8.57%,将其归为暴露困难组.64例未发生声门暴露困难,归为对照组.采用0°内镜时,两组舌平面评分1~3分有8例,而30°内镜和70°内镜时的例数仅为3例和0例.对照组Friedman舌根分级Ⅲ级、Ⅳ级共23例,困难暴露组Friedman舌根分级Ⅲ级、Ⅳ级共4例.Pearson相关性分析,舌平面评分、会厌上缘评分和声门暴露困难呈负相关(P<0.05).Friedman舌根分级和声门暴露困难呈正相关(P<0.05).结论术前测量患者的舌平面评分、会厌上缘评分、Friedman舌根分级,对预测患者是否为支撑喉镜下声门暴露困难有重要意义.

Objective To explore the value of endoscopy in predicting the difficulties of glottic exposure and provide reference for preoperative evaluation. Methods Seventy patients who underwent elective laryngeal microsurgical laryngeal lesions were included in the study, who were enrolled in Shenzhen Nanshan District Shekou People' s Hospital from January 2017 to October 2018. According to the situation of the glottis exposure, the patients with the difficulty of Ⅲ/Ⅳdegree in glottis exposure were classified as the experimental group of the exposure difficulty;the patients with the difficulty of Ⅰ/Ⅱ degree were in the control group. The tongue plane score and the epiglottis upper edge score were observed in the glottis exposed group and the control group, and the Friedman tongue root grading was observed in the two groups. The correlations of tongue plane scoring, upper episode score, Friedman 's tongue grading, and glottic exposure difficulties was analyzed. Results 6 cases of the 70 patients with the difficulty of glottic exposure during surgery, an incidence of 8. 57%, were classified as the experimental group. 64 cases of the 70 patients did not have difficulty in glottic exposure and were classified as a control group. Corresponding to the using of 0°, 30° and 70° endoscopy, there were 8 cases, only 3 cases and 0 cases with a score of 1 to 3 points in the two groups respectively. According to Ⅲ/Ⅳdegree of Friedman's tongue root, there were a total of 23 cases in the control group, and 4 cases in the experimental group. Pearson correlation analysis, tongue plane score and upper episode score were negatively correlated to glottic exposure (P <0. 05). Friedman 's tongue root grading was positively correlated to glottis exposure ( P <0. 05 ). Conclusion Preoperative measurement of the patient's tongue plane score, upper episode score, and Friedman's tongue root grading is of great significance in in predicting the difficulties of glottic exposure under laryngoscope.