Havstam Christina, Lohmander Anette, Persson Christina, Dotevall Hans, Lith Agneta, Lilja Jan
Department of Logopedics and Phoniatrics, Institute of Selected Clinical Sciences, Sahlgrenska Academy at Göteborg University, SE-405 30 Göteborg, Sweden.
Br J Plast Surg. 2005 Oct;58(7):922-31. doi: 10.1016/j.bjps.2005.02.012.
The purpose of this study was to investigate how different amounts of visual assessment information influence the recommended treatment for velopharyngeal insufficiency (VPI). Is a patient presented with videofluoroscopy (VF) in lateral projection recommended the same treatment as when frontal projection, nasoendoscopy, or both, are added? Retrospective material with video recorded assessment of VPI was blinded and copied in random order. Each patient was then presented in four separate combinations: VF in lateral projection; VF in lateral and frontal projection; VF in lateral projection and nasoendoscopy; and VF in lateral and frontal projection and nasoendoscopy (all of the available assessment material). The cleft palate team of Göteborg, Sweden, mutually rated velopharyngeal function and recommended action based on the presented material.
Nineteen consecutive patients (median age 7:5 years, range 4:4-19:7) investigated with VF in lateral and frontal projection and nasoendoscopy during 1997-99 at the cleft palate centre in Göteborg, Sweden. Post operative assessments were excluded. Percent agreement and Kappa calculations were used to compare the different combinations of parts of information to all of the available information.
Thirteen of the 19 patients (68%) were recommended the same action regardless of the amount of presented information. Percent agreement (Kappa) between parts and all of the available information: VF in lateral projection 84% (0.75), VF in lateral and frontal projection 79% (0.74), and VF in lateral projection and nasoendoscopy 84% (0.72).
VF in lateral projection is recommended to be the first step in visualising velopharyngeal function, and nasoendoscopy the next when further investigation is required.
本研究的目的是调查不同数量的视觉评估信息如何影响对腭咽功能不全（VPI）的推荐治疗方案。对于仅呈现侧位投影的视频荧光造影（VF）的患者，其推荐治疗方案与同时增加正位投影、鼻内镜检查或两者都有的情况相同吗？对记录有VPI评估视频的回顾性资料进行了盲法处理，并按随机顺序复制。然后，以四种不同的组合呈现每位患者：侧位投影的VF；侧位和正位投影的VF；侧位投影的VF和鼻内镜检查；以及侧位和正位投影的VF以及鼻内镜检查（所有可用的评估资料）。瑞典哥德堡的腭裂治疗团队根据所呈现的资料对腭咽功能进行相互评分并推荐治疗措施。
1997年至1999年期间，在瑞典哥德堡腭裂中心对19例连续患者（中位年龄7.5岁，范围4.4至19.7岁）进行了侧位和正位投影的VF以及鼻内镜检查。排除术后评估。使用一致性百分比和Kappa计算来比较部分信息的不同组合与所有可用信息。
19例患者中有13例（68%）无论所呈现信息的数量如何，都被推荐了相同的治疗措施。部分信息与所有可用信息之间的一致性百分比（Kappa）：侧位投影的VF为84%（0.75），侧位和正位投影的VF为79%（0.74），侧位投影的VF和鼻内镜检查为84%（0.72）。
推荐侧位投影的VF作为可视化腭咽功能的第一步，当需要进一步检查时，鼻内镜检查为下一步。
