目的 分析喉手术中声门暴露困难（difficult laryngeal exposure, DLE）的危险因素及可调式支撑喉镜在其中的应用。方法 收集2020年12月—2021年12月期间诊断为声带良性病变,拟进行支撑喉镜喉微创外科手术患者的病例资料。单因素及多因素分析DLE的危险因素。对DLE患者采用可调式支撑喉镜。结果 48例DLE患者中,有45例（93.75%）经可调式支撑喉镜手术成功,3例改为电子喉镜进行手术。经单因素分析发现,体重指数（BMI）、颈围、胸颏距（SMD）、舌颏距（HMD）、甲颏距（TMD）、舌体厚度、髁状凸活动度、Yamamoto分级及MMT分级与DLE有关（P<0.05）。多因素logistic回归分析,结果显示,BMI≥25 kg/m2、颈围≥40 cm、TMD<7 cm、舌体厚度≥60 mm、髁状凸活动度≥10 mm是DLE的影响因素。绘制影响因素的ROC曲线,结果显示髁状凸活动度和舌体厚度的ROC曲线下面积为0.881和0.845,这两个因素预测价值较高。结论 BMI、颈围、TMD、舌体厚度及髁状凸活动度可作为DLE的预测因素,其中舌体厚度及髁状凸活动度能够作为DLE的独立预测因子。对于DLE患者,大部分可通过可调式支撑喉镜来完成手术。
Objective To analyze the risk factors of difficult laryngeal exposure (DLE) in laryngeal surgery and the application of adjustable support laryngoscope. Methods The data of patients who were diagnosed with benign vocal cord lesions in our hospital from December 2020 to December 2021 and ordered minimally invasive laryngeal surgery with support laryngoscope were collected. Univariate and multivariate analyses were conducted to identify risk factors for DLE. An adjustable support laryngoscope was applied for DLE patients. Results Of the 48 patients with DLE, 45 (93.75%) were successful operations via adjustable support laryngoscopy, and 3 were converted to electronic laryngoscopy for the procedure. Univariate analysis showed that body mass index (BMI), neck circumference, sternomental distance (SMD), hyoid-mental distance (HMD), thyromental distance (TMD), tongue thickness, condyle range of motion, Yamamoto grade, and MMT grade were associated with DLE (P<0.05). Multiple logistic regression analysis showed that BMI≥25 kg/m2, neck circumference≥40 cm, TMD<7 cm, tongue thickness≥60 mm, and condyle range of motion≥10 mm were the influencing factors of DLE. The ROC curve of the influencing factors showed that the areas under the ROC curve of the condyle range of motion and tongue thickness were 0.881 and 0.845 respectively. Conclusion BMI, neck circumference, TMD, tongue thickness, and condyle range of motion can be used as predictors of DLE, and tongue thickness and condyle range of motion can be independent predictors of DLE. For DLE patients, most surgeries can be done with an adjustable support laryngoscope.
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