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Computational Fluid Dynamics Analysis of Surgical Approaches to Bilateral Vocal Fold Immobility.

双侧声带不动手术入路的计算流体动力学分析。

  • 影响因子:2.32
  • DOI:10.1002/lary.27925
  • 作者列表:"Rios G","Morrison RJ","Song Y","Fernando SJ","Wootten C","Gelbard A","Luo H
  • 发表时间:2020-02-01
Abstract

OBJECTIVES:Bilateral vocal fold immobility (BVFI) is a rare and life-threatening condition in which both vocal folds are fixed, resulting in airway obstruction associated with life-threatening respiratory compromise. Treatment of BVFI is largely surgical and remains an unsatisfactory compromise between voice, breathing, and swallowing. No comparisons between currently employed techniques currently exist. We sought to employ computational fluid dynamics (CFD) modeling to delineate the optimal surgical approach for BVFI. METHODS:Utilizing clinical computed tomography of BVFI subjects, coupled with image analytics employing CFD models and subject pulmonary function data, we compared the airflow features in the baseline pathologic states and changes seen between endoscopic cordotomy, endoscopic suture lateralization, and posterior cricoid expansion. RESULTS:CFD modeling demonstrated that the greatest airflow velocity occurs through the posterior glottis on inspiration and anterior glottis on expiration in both the normal condition and in BVFI. Glottic airflow velocity and resistance were significantly higher in the BVFI condition compared to normal. Geometric indices (cross-sectional area of airway) were lower in posterior cricoid expansion surgery when compared to alternate surgical approaches. CFD measures (airflow velocity and resistance) improved with all surgical approaches but were superior with posterior cricoid expansion. CONCLUSION:CFD modeling can provide discrete, quantitative assessment of the airflow through the laryngeal inlet, and offers insights into the pathophysiology and changes that occur after surgery for BVFI. LEVEL OF EVIDENCE:NA. Laryngoscope, 130:E57-E64, 2020.

摘要

目的: 双侧声带不动 (BVFI) 是一种罕见且危及生命的疾病,其中两个声带固定,导致气道阻塞与危及生命的呼吸损害相关。BVFI的治疗主要是外科手术,并且在声音、呼吸和吞咽之间仍然是不令人满意的折衷。目前不存在目前采用的技术之间的比较。我们试图采用计算流体动力学 (CFD) 模型来描绘BVFI的最佳手术方法。 方法: 利用BVFI受试者的临床计算机断层扫描,结合使用CFD模型和受试者肺功能数据的图像分析,我们比较了基线病理状态下的气流特征以及内镜下皮质切开术、内镜下缝线偏侧化和后环状软骨扩张之间的变化。 结果: CFD模型表明,在正常条件下和在BVFI中,最大的气流速度在吸气时通过后声门,在呼气时通过前声门。声门气流速度和阻力在BVFI条件下显著高于正常。与其他手术方法相比,后环状软骨扩张手术的几何指数 (气道横截面积) 较低。CFD测量 (气流速度和阻力) 在所有手术入路中均得到改善,但在后环状软骨扩张时优于 结论: CFD建模可以提供通过喉入口的气流的离散,定量评估,并提供对BVFI手术后发生的病理生理学和变化的见解。 证据级别: NA。喉镜,130:E57-E64,2020。

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影响因子:2.98
发表时间:2020-01-01
DOI:10.1136/neurintsurg-2019-014962
作者列表:["Guo W","Liu H","Tan Z","Zhang X","Gao J","Zhang L","Guo H","Bai H","Cui W","Liu X","Wu X","Luo J","Qu Y"]

METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

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DOI:10.1002/jcu.22762
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