Nouraei S A R, McPartlin D W, Nouraei S M, Patel A, Ferguson C, Howard D J, Sandhu G S
Department of Otolaryngology-Head and Neck Surgery, Charing Cross Hospital, London, UK.
Laryngoscope. 2006 Jan;116(1):12-7. doi: 10.1097/01.mlg.0000186657.62474.88.
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.
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.
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, increasing to 141.1 mm after laser therapy. Two independent observers calculated airway cross-sections, achieving an interobserver concordance of 0.98.
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.
在气道狭窄患者中，病变的解剖结构决定了生物力学通气障碍的程度，进而决定了症状的性质和严重程度。它还能提供有关喉气管病变的生物学特性、对治疗反应的可能性以及预后的信息。因此，在整个治疗过程中准确测量气道大小对于管理这种疾病至关重要。我们开发了一种在内镜检查期间客观评估气道病变的方法。
我们使用气道模拟来研究内镜倾斜和镜头畸变对测量准确性的影响，制定并验证了定量气道内镜检查的临床规则。设计了一种校准器，用于在气管镜检查期间评估病变的长度、位置和横截面。
事实证明，使用简单的数学方法就可以计算出狭窄的长度和位置。对于儿童和成人气道尺寸，横截面测量的准确率超过95%，与内镜倾斜无关，且无需对内镜光学和视觉空间畸变做出假设。该技术用于对10名平均年龄48岁的成年患者进行治疗性喉气管镜检查时的气道病变进行特征描述。病变平均发生在声门下方36 mm处（范围为21 - 54 mm），长度为9.3 mm（5 - 17 mm）。治疗前气道平均横截面为48.3 mm，激光治疗后增加到141.1 mm。两名独立观察者计算气道横截面，观察者间一致性为0.98。
该方法可用于客观、精确地确定气道病变的解剖结构，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，并比较不同中心的治疗结果。
