摘要
目的探讨应用三维CT(3D-CT)重建容积测量法预测口咽肿瘤患者插管困难的价值。方法36例舌根或口底肿瘤患者,术前于插管嗅花位下行螺旋CT扫描。采用SimplantCMF11.2的3D-CT重建软件进行16项指标的测量和计算:舌体容积(VT)、口咽空腔容积(VA)、口咽腔容积(VO),舌体矢状面截面积(SSAT)、空腔矢状面截面积(SSAA)和口咽腔矢状面截面积(SSAO),舌体冠状面截面积(CSAT)、空腔冠状面截面积(CSAA)和口咽腔冠状面截面积(CSAO),舌体横截面积(ASAT)、空腔横截面积(ASAA)和口咽腔横截面积(ASAO),舌体与口咽腔容积比(VT/VO)、矢状面截面积比(SSAT/SSAO)、冠状面截面积比(CSAT/CSAO)及横截面积比(ASAT/ASAO)。插管前进行Mallampati试验和Wilson评分。实施全身麻醉后,Cormack-LehaneⅢ～Ⅳ级的患者作为插管困难组(12例);Cormack-LehaneⅠ～Ⅱ级的患者作为非插管困难组(24例)。比较两组的16项指标,并选取相关指标进行Logistic回归分析。比较3D-CT重建测量、Mallampati试验和Wilson评分预测插管困难的敏感性、误诊率、漏诊率及特异性。结果插管困难组的VT、VT/VO均显著高于非插管困难组(P值均<0.05),VA显著低于非插管困难组(P<0.05)。插管困难组矢状面的SSAT、SSAT/SSAO显著高于非插管困难组(P值均<0.05),SSAA显著低于非插管困难组(P<0.05);横截面的ASAA显著低于非插管困难组(P<0.05),ASAT/ASAO显著高于非插管困难组(P<0.05)。Logistic回归分析显示,VT/VO是插管困难的危险因素(OR=3.870,P<0.05)。以3D-CT重建容积测量(VT/VO>0.5)、Mallampati试验(Ⅲ～Ⅳ级)、Wilson评分(≥4分)分别预测插管困难,3D-CT重建容积测量的敏感性显著高于Mallampati试验和Wilson评分(P值均<0.05),误诊率显著低于Mallampati试验(P<0.05),漏诊率显著低于Mallampati试验和Wilson评分(P值均<0.05),特异性显著高于Mallampati试验(P<0.05)。结论3D-CT重建测量可用于口咽肿瘤患者插管困难的预测,VT/VO>0.5可作为有效的定量预测指标。
Objective To investigate the clinical value of the volume measurement using 3D-CT reconstruction technology in predicting difficult intubation in patients with oropharyngeal tumor. Methods Helical CT scanning was performed in 36 patients with tongue root or mouth floor tumor under the sniffing position preoperatively. Reconstructed images were obtained by Simplant CMF 11.2 system and the following parameters were analyzed： 3D-CT involving volume of tongue （VT）, volume of airway （VA）, volume of oropharyngeal （VO）, sagittal section area of tongue （SSAT）, segittal section area of airway （SSAA）, segittal section area of oropharyngeal （SSAO）, coronal section area of tongue （CSAT）, coronal section area of airway （CSAA）, coronal section area of oropharyngeal （CSAO）, axial section area of tongue （ASAT）, axial section area of airway （ASAA）, axial section area of oropharyngeal （ASAO）, VT/VO, SSAT/SSAO, CSAT/CSAO and ASAT/ASAO. Patients were assigned to difficult intubation group with Cormack-Lehane grade Ⅲ - Ⅳ and non-difficult intubation group with Cormack-Lehane grade Ⅰ - Ⅱ . Results were compared with those obtained by Mallampati test （ Ⅲ- Ⅳ ） or Wilson score system （≥4） .P, esutts There were 12 patients in difficult intubation group and 24 patients in non-difficult intubation group according to Cormack-Lehane grade. VT, SSAT, VT/VO, SSAT/SSAO and ASAT/ASAO were significantly higher while VA, SSAA and ASAA were significantly lower in difficult intubation group compared with those in the non-difficult intubation group（all P〈0. 05）. Logistic regression analysis showed that VT/VO was an independent risk factor of difficult intubation （relative risk, 3,870, P〈0.05）. Using VT/VO〉0.5 as reference value, the predicting sensitivity for difficult intubation （91.7%） was significantly higher than that by Mallampati test （83.3 % ） and Wilson score system（33.33%, all P.〈0. 05）; the false negative rate （8.3%） was significantly lower than that from Mallampati test （ 16.7% ） and Wilson score system （66.7%）; the false positive rate （ 12.5% ） was similar as that by Willson score system （ 12.5% ）, but significantly lower than by from Mallampati test （58.3%, P〈0.05）. Conclusion VT/VO〉0.5 obtained from 3D-CT reconstruction measurement is a satisfactory reference value for predicting difficult intubation in patients with oropharyngeal tumor.
出处
《上海医学》
CAS
CSCD
北大核心
2009年第1期29-33,I0001,共6页
Shanghai Medical Journal
基金
上海市卫生局基金资助项目(054051)
关键词
口咽肿瘤
三维CT重建
困难气道
Oropharyngeal tumor
3D-CT reconstruction
Difficult airway
