Wang Mengshu, Liu Yong, Qiu Yuanzheng, Chen Huihong, Liwen Wang, Huang Donghai, Zhang Xin, Li Guo
Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.
Otolaryngology Major Disease Research, Key Laboratory of Hunan Province, Changsha, China.
Clin Exp Otorhinolaryngol. 2024 May;17(2):177-187. doi: 10.21053/ceo.2023.00023. Epub 2024 Apr 25.
Considerable research has been focused on independent predictors of difficult laryngeal exposure (DLE) during suspension laryngoscopy. However, previous studies have yielded inconsistent results and conclusions. Consequently, we performed a meta-analysis of the existing literature with the aim of identifying significant parameters for a standardized preoperative DLE prediction system.
We systematically retrieved articles from the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang databases up to October 2022. Data from eligible studies were extracted and analyzed using the R programming language. The effect measures included odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous variables and mean differences (MDs) with 95% CIs for continuous variables.
The search yielded 1,574 studies, of which 18 (involving a total of 2,263 patients) were included. Pooled analysis demonstrated that patients with DLE during microsurgery tended to be male (OR, 1.73; 95% CI, 1.16-2.57); were older (MD, 5.47 years, 95% CI, 2.44-8.51 years); had a higher body mass index (BMI; MD, 1.19 kg/m2; 95% CI, 0.33-2.05 kg/m2); had a greater neck circumference (MD, 2.50 cm; 95% CI, 1.56-3.44 cm); exhibited limited mouth opening (MD, -0.52 cm; 95% CI, -0.88 to -0.15 cm); had limited neck flexibility (MD, -10.05 cm; 95% CI, -14.10 to -6.00 cm); displayed various other anatomical characteristics; and had a high modified Mallampati index (MMI) or test score (OR, 3.37; 95% CI, 2.07-5.48).
We conducted a comprehensive and systematic analysis of the factors relevant to DLE. Ultimately, we identified sex, age, BMI, neck circumference, MMI, inter-incisor gap, hyomental distance, thyromental distance, sternomental distance, and flexion-extension angle as factors highly correlated with DLE.
大量研究聚焦于支撑喉镜检查期间困难喉镜暴露（DLE）的独立预测因素。然而，既往研究结果和结论并不一致。因此，我们对现有文献进行了荟萃分析，旨在确定标准化术前DLE预测系统的重要参数。
我们系统检索了截至2022年10月的PubMed、Embase、Web of Science、中国知网和万方数据库中的文章。使用R编程语言对符合条件的研究数据进行提取和分析。效应量包括二分类变量的比值比（OR）及其95%置信区间（CI），以及连续变量的均值差（MD）及其95%CI。
检索到1574项研究，其中18项（共涉及2263例患者）被纳入。汇总分析表明，显微手术期间发生DLE的患者往往为男性（OR，1.73；95%CI，1.16 - 2.57）；年龄较大（MD，5.47岁，95%CI，2.44 - 8.51岁）；体重指数（BMI）较高（MD，1.19 kg/m²；95%CI，0.33 - 2.05 kg/m²）；颈围较大（MD，2.50 cm；95%CI，1.56 - 3.44 cm）；张口受限（MD， - 0.52 cm；95%CI， - 0.88至 - 0.15 cm）；颈部活动度受限（MD， - 10.05 cm；95%CI， - 14.10至 - 6.00 cm）；具有其他各种解剖学特征；改良Mallampati指数（MMI）或测试评分较高（OR，3.37；95%CI，2.07 - 5.48）。
我们对与DLE相关的因素进行了全面系统的分析。最终，我们确定性别、年龄、BMI、颈围、MMI、门齿间距、颏下距离、甲状软骨上切迹至颏部距离、胸骨上切迹至颏部距离以及屈伸角度为与DLE高度相关的因素。
