Objective sizing of upper airway stenosis: A quantitative endoscopic approach
Objective sizing of upper airway stenosis: A quantitative endoscopic approach
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DOI：
10.1097/01.mlg.0000186657.62474.88
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发表时间：
2006-01-01
期刊：
影响因子：
2.6
通讯作者：
Sandhu, GS
中科院分区：
文献类型：
--
作者：
Nouraei, SAR;McPartlin, DW;Sandhu, GS
目标。在有气道狭窄的患者中，病变的解剖决定了生物力学呼吸障碍的大小，从而决定了症状的性质和严重程度。它还提供了有关喉气管病变的生物学、治疗反应的可能性和预后的信息。因此，在整个治疗过程中，准确的气道大小是管理这种情况的核心。我们开发了一种在内窥镜检查中客观评估呼吸道损害的方法。方法：研究方法。我们使用呼吸道模拟来研究内窥镜倾斜和透镜扭曲对测量准确性的影响，设计并验证定量呼吸道内窥镜的临床规则。设计了一种校准器，用于在气管镜检查中评估病变的长度、位置和横断面。结果：可以用简单的数学方法计算出狭窄的长度和位置。对于儿童和成人的呼吸道尺寸，横断面测量的准确率超过95%，不受内窥镜倾斜的影响，也不会对内窥镜光学和视觉空间扭曲做出假设。这项技术被用来描述10名平均年龄为48岁的接受治疗性喉气管镜检查的成人患者的呼吸道病变。病变位于声门下方平均36 mm(21~54 mm)，长9.3 mm(5~17 mm)。治疗前平均气道横截面积为48.3mm2，激光治疗后增加到141.1 mm(2)。两个独立的观察者计算了气道横截面，观察者间的一致性为0.98。结论。该方法可用于客观和准确地确定呼吸道病变的解剖结构，从而准确记录病变特征和手术结果，在整个治疗过程中进行连续监测，并比较不同中心之间的结果。
Objective. In patients with airway stenosis, anatomy of the lesion determines the magnitude of the biomechanical ventilatory disturbance and thus the nature and severity of symptoms. It also gives information about biology, likelihood of response to treatment, and prognosis of laryngotracheal lesions. Accurate airway sizing throughout treatment is therefore central to managing this condition. We developed a method for objective assessment of airway lesions during endoscopy. Methods. We used airway simulations to investigate the effects of endoscope tilt and lens distortions on measurement accuracy, devising and validating clinical rules for quantitative airway endoscopy. A calibrator was designed to assess lesion length, location, and cross-section during tracheoscopy. Results: It proved possible to calculate the length and location of the stenosis using simple mathematics. Cross-section measurements were more than 95% accurate, independent of endoscope tilt and without making assumptions about endoscope optics and visuospatial distortion, for both pediatric and adult airway dimensions. The technique was used to characterize airway lesions in 10 adult patients with an average age of 48 years undergoing therapeutic laryngotracheoscopy. Lesions occurred on average 36 mm below the glottis (range, 21-54 mm) and were 9.3 mm long (5-17 mm). The average pretreatment airway cross-section was 48.3 mm(2), increasing to 141.1 mm(2) after laser therapy. Two independent observers calculated airway cross-sections, achieving an interobserver concordance of 0.98. Conclusions. This method can be used to objectively and precisely determine the anatomy of airway lesions, allowing accurate documentation of lesion characteristics and surgical results, serial monitoring throughout treatment, and comparison of outcomes between different centers.