The Clinical Evaluation On Respire In Patients After Partial Laryngectomy With Multi-Detector CT (MDCT)

Object:We use multi-detector computerized tomography (MDCT) to evaluate the 3D characteristics of the laryngeal structures in patients after partial Iaryngectomy, try to find the actual relationships between their breath and their laryngeal structures of patients undergoing partial laryngectomy. Find the reasons of it. Then we want to know whether the laryngeal characteristics could be the measure of decannulation or not. Try to find a new method of evaluation on respire in patients after partial laryngectomy.Methods:The subjects were 21 men after partial laryngectomy who underwent MDCT examination between May 2005 and February 2006, and had no trace of recurrence. Every subject underwent examination on normal stage (no swallowing) and deep breathing stage with PHILIPS Brilliance ? 16 CT. Then we made the multiplannar reformation of cross, coronal, and sagittal sections on any point of view with Extended PHILIPS Brilliance ? Workspace 2.0.11. Measured the variables as S-the minimum area on the cross section on normal stage, IS- the minimum area on the cross sectionon deep breathing stage, So- the tracheal area on transect of cricoid cartilage(as the area of the trachea), H- distance of the narrow, et al. We also collected the history about having cannula or not(Y), age, pathological stage, type of partial laryngectomy, radiotherapy, re- tracheotomy, time after operation, et al. Then we used SPSS 13.0 to analyse the result of these variables, by Spearman's test , logistic regression, and so on.Results:Three of the 21 men didn't have the decannulation, the rate is 14.3%.1. By Spearman's Test, we found that whether patients having cannulas or not(Y), have significant negative correlation with S;and Y have significant negative correlation with the rate of S/ So> too.2. H entered the logistic regression model of Y, b=0.214, OR=1;the constant=-0.37.3. The recover of patients' respire had no relationship to their ages, pathological stages, types of partial laryngectomy, radiotherapy, re- tracheotomy, time after operation, et al.4. Causes of narrow:We found that H have positive correlation with which type of partial laryngectomy the subject had, and the patient's H have positive correlation with his history of radiotherapy, with Spearman's Test.5. Other interesting results:a) The type of partial laryngectomy had significant positive correlation with the pathological stage.b) The opportunity of re-cannulation had significant positive correlation with the time after operation.c) When the dependent variable is IS, the independent variable is S, the liner regression model can be made, as IS=33.207(± 10.765)+0.846(±0.192)S.Conclusion:1. As a result: we found that whether patients having cannulas or not, haveconnections with S and H, so it is ture that the respiratory ruction of patients after partial laryngectomy is related to their 3D characteristics of the laryngeal structures., We found the logistic regression model of H and Y at the same time. It clue to that H can be a measure of evaluation the laryngeal respire. By the way , we have a new way to low down the risk of the decannulation.2. Series of types of partial laryngectomy have their own way to effect the rate of decannulation by change the length of narrow. Radiotherapy also effect the distance of narrow, then it may cause low decannulation rate or high recannulation rate. So we should pay more attention on deciding an appropriate type of laryngectomy, or the guideline of radiotherapy, or an aptitudinal occasion of decannulation.3. Finally, we recommend that the methods of this thesis is an easy, and economical way of the new evaluation of breath function of larynx after partial laryngectomy.