Woo Jung-Woo, Park Inhye, Choe Jun Ho, Kim Jung-Han, Kim Jee Soo
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Surgery, Gyeongsang National University Changwon Hospital and Gyeongsang National University School of Medicine, Changwon, South Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Surgery. 2017 Apr;161(4):1108-1112. doi: 10.1016/j.surg.2016.10.013. Epub 2016 Nov 18.
Laryngeal ultrasound is a new method of vocal cord evaluation in patients at risk for vocal cord palsy. However, the previously described laryngeal ultrasound reportedly has a high failure rate of vocal cord visualization in male patients. We compared 2 ultrasound frequencies in laryngeal ultrasound to improve on the limitations of this method.
A total of 301 (55 male, 246 female) consecutive laryngeal ultrasound and direct laryngoscopy exams were performed for patients with thyroidectomy and other neck operations. High-frequency transducer (12-5 MHz broad band spectrum) and low-frequency transducer (9-3 MHz broad band spectrum) were used for all laryngeal ultrasound. Findings were independently cross-validated with direct laryngoscopy.
High-frequency and low-frequency laryngeal ultrasound had 88.4% and 97.7% visualization rates, respectively. In addition, low-frequency laryngeal ultrasound showed improved sensitivity of 97.6% and specificity of 96.5%, compared with a sensitivity of 92.9% and specificity of 86.5% for high-frequency laryngeal ultrasound in vocal cord evaluation.
The low-frequency laryngeal ultrasound method significantly enhances the visualization of vocal cords, especially in patients who have diffuse thyroid cartilage calcification interrupting laryngeal ultrasound, and therefore enhances the overall efficacy of laryngeal ultrasound as a perioperative diagnostic tool for vocal cord palsy. Hence, we recommend using a low-frequency transducer (about 9-3 MHz) for laryngeal ultrasound if it is available.
对于有喉返神经麻痹风险的患者，喉部超声是一种评估声带的新方法。然而，据报道，先前描述的喉部超声在男性患者中声带可视化的失败率较高。我们比较了喉部超声中的两种超声频率，以改善该方法的局限性。
对接受甲状腺切除术和其他颈部手术的患者连续进行了301次（55例男性，246例女性）喉部超声和直接喉镜检查。所有喉部超声均使用高频探头（12 - 5MHz宽带频谱）和低频探头（9 - 3MHz宽带频谱）。检查结果与直接喉镜检查进行独立交叉验证。
高频和低频喉部超声的可视化率分别为88.4%和97.7%。此外，在声带评估中，低频喉部超声的敏感性提高到97.6%，特异性为96.5%，而高频喉部超声的敏感性为92.9%，特异性为86.5%。
低频喉部超声方法显著提高了声带的可视化程度，特别是对于那些甲状腺软骨广泛钙化而中断喉部超声检查的患者，因此提高了喉部超声作为围手术期声带麻痹诊断工具的整体效能。因此，如果有条件，我们建议在喉部超声检查中使用低频探头（约9 - 3MHz）。
