高频超声评价甲状腺术前声带运动的临床研究
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摘要
目的探讨高频超声在甲状腺术前声带运动检查中的临床价值。方法对2015年3月～2018年7月在我院行甲状腺手术的157例患者行喉镜和超声检查,对声带运动进行评级:Ⅰ级(正常),双侧声带对称性运动;Ⅱ级,一侧声带较对侧声带运动幅度减低;Ⅲ级,一侧声带位置固定。Ⅱ、Ⅲ级为声带运动障碍即声带麻痹。以喉镜为金标准,比较高频超声的一致性。结果超声诊断声带麻痹的符合率为98.6%,敏感度为88.9%,漏诊率为11.1%,特异度为99.%,误诊率为0.8%。一致性分析显示,超声评价与喉镜具有高度一致性(P<0.001)。结论高频超声评价声带麻痹与喉镜相比较具有几乎一致性的诊断性,可用于甲状腺术前声带运动的评估。
Objective To evaluate the clinical value of vocal cord movement before thyroidectomy by high frequency ultrasound. Methods One hundred and fifty-seven patients underwent thyroidectomy from Mar. 2013 to Jul. 2018 were collected as the research objects. All patients underwent ultrasound and direct laryngoscopy test before thyroidectomy. The extent of movement was graded from Ⅰ to Ⅲ. Grade Ⅰ meant full or normal symmetric movement of both vocal cords, whereas grade Ⅱ meant impaired or decreased movement, and grade Ⅲ meant no movement. The results of laryngoscopy were used as the gold standard to assess the consistency of ultrasound findings. Results Ultrasound diagnosis of vocal cord paresis or palsy had a sensitivity, specificity, the concordance rate, the rate of missed diagnosis, and misdiagnosis rate of 88.9%,99.2%,98.6%,11.1% and 0.8%,respectively(P<0.001). Conclusions Ultrasonography has a high value in the diagnosis and can be used for the peroperative evaluation of vocal cord movement before thyroidectomy.
Objective To evaluate the clinical value of vocal cord movement before thyroidectomy by high frequency ultrasound. Methods One hundred and fifty-seven patients underwent thyroidectomy from Mar. 2013 to Jul. 2018 were collected as the research objects. All patients underwent ultrasound and direct laryngoscopy test before thyroidectomy. The extent of movement was graded from Ⅰ to Ⅲ. Grade Ⅰ meant full or normal symmetric movement of both vocal cords, whereas grade Ⅱ meant impaired or decreased movement, and grade Ⅲ meant no movement. The results of laryngoscopy were used as the gold standard to assess the consistency of ultrasound findings. Results Ultrasound diagnosis of vocal cord paresis or palsy had a sensitivity, specificity, the concordance rate, the rate of missed diagnosis, and misdiagnosis rate of 88.9%,99.2%,98.6%,11.1% and 0.8%,respectively(P<0.001). Conclusions Ultrasonography has a high value in the diagnosis and can be used for the peroperative evaluation of vocal cord movement before thyroidectomy.
引文
[1] 代文杰.甲状腺癌规范化诊断和治疗的重要性[J].临床外科杂志,2015,23(7):485-486.
[2] HARTL D M,TRAVAGLI J P,LEBOULLEUX S,et al.Clinical review:current concepts in the management of unilateral recurrent laryngeal nerve paralysis after thyroid surgery[J].J Clin Endocrinol Metab,2005,90(5):3084-3088.
[3] 武静芳,李雪梅,郭忆.高频超声对成人喉部结构显示情况的研究[J] .中国眼耳鼻喉科杂志,2017,17(6):408-411.
[4] WONG K P,LANG B H,NG S H,et al.A prospective,assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy[J].Surgery,2013,154(6):1158-1164.
[5] 覃折波,何芸,冯玉洁,等,正常成人声带区解剖结构的超声成像[J].临床超声医学杂志,2017,19(1):14-17.
[6] WONG K P,WOO J W,YOUN Y K,et al.The importance of sonographic landmarks by transcutaneous laryngeal ultrasonography in post-thyroidectomy vocal cord assessment[J].Surgery,2014,156(6):1590-1596.
[7] WONG K P,LANG B H,CHANG Y K,et al.Assessing the validity of transcutaneous laryngeal ultrasonography (TLUSG) after thyroidectomy:what factors matter?[J].Ann Surg Oncol,2015,22 (6):1774-1780.
[8] 周伟,马岩,方益荣,等,浙江省绍兴市2009年至2013年甲状腺癌检出率及时间趋势分析[J].中华内分泌代谢杂志,2015,31(1):4-9.
[9] 闫慧娴,谷伟军,吕朝晖,等.结节大小与甲状腺癌风险的临床研究[J].中华内分泌代谢杂志,2015,31(1):10-13.
[10] 孙嘉伟,许晓君,蔡秋茂,等.中国甲状腺癌发病趋势分析[J].中国肿瘤,2013,22(9):690-693.
[2] HARTL D M,TRAVAGLI J P,LEBOULLEUX S,et al.Clinical review:current concepts in the management of unilateral recurrent laryngeal nerve paralysis after thyroid surgery[J].J Clin Endocrinol Metab,2005,90(5):3084-3088.
[3] 武静芳,李雪梅,郭忆.高频超声对成人喉部结构显示情况的研究[J] .中国眼耳鼻喉科杂志,2017,17(6):408-411.
[4] WONG K P,LANG B H,NG S H,et al.A prospective,assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy[J].Surgery,2013,154(6):1158-1164.
[5] 覃折波,何芸,冯玉洁,等,正常成人声带区解剖结构的超声成像[J].临床超声医学杂志,2017,19(1):14-17.
[6] WONG K P,WOO J W,YOUN Y K,et al.The importance of sonographic landmarks by transcutaneous laryngeal ultrasonography in post-thyroidectomy vocal cord assessment[J].Surgery,2014,156(6):1590-1596.
[7] WONG K P,LANG B H,CHANG Y K,et al.Assessing the validity of transcutaneous laryngeal ultrasonography (TLUSG) after thyroidectomy:what factors matter?[J].Ann Surg Oncol,2015,22 (6):1774-1780.
[8] 周伟,马岩,方益荣,等,浙江省绍兴市2009年至2013年甲状腺癌检出率及时间趋势分析[J].中华内分泌代谢杂志,2015,31(1):4-9.
[9] 闫慧娴,谷伟军,吕朝晖,等.结节大小与甲状腺癌风险的临床研究[J].中华内分泌代谢杂志,2015,31(1):10-13.
[10] 孙嘉伟,许晓君,蔡秋茂,等.中国甲状腺癌发病趋势分析[J].中国肿瘤,2013,22(9):690-693.