Application of virtual endoscopy in the diagnosis of adenoid hypertrophy and the morphologic classification of adenoid
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摘要: 目的 探讨仿真内镜在腺样体肥大诊断和腺样体形态分型中的应用价值。方法 收集深圳大学总医院耳鼻咽喉头颈外科2022年7月—2022年12月收治的97例腺样体肥大患儿的临床资料，利用锥形束计算机断层扫描对鼻咽部进行仿真内镜重建，比较仿真内镜下腺样体大小测量结果与鼻咽CT正中矢状位结果和鼻咽内镜检查结果的一致性；仿真内镜下根据腺样体大小及其与咽鼓管圆枕之间的关系对腺样体形态进行分型。结果 仿真内镜与鼻咽CT两种方法测量腺样体大小的t检验结果为1.699、P=0.093，组内相关系数(ICC)分析结果为0.921、P＜0.01，仿真内镜与鼻咽CT两种方法所测腺样体占比具有高度一致性；仿真内镜与鼻咽内镜两种方法测量腺样体大小的t检验结果为1.453、P=0.15，ICC=0.900、P＜0.01，仿真内镜与鼻咽内镜两种方法所测腺样体占比具有高度一致性。97例患儿中，腺样体形态分型结果为整体肥大型48例，中央隆起型47例，平坦增厚型2例。结论 利用仿真内镜进行腺样体肥大诊断具有较高的准确性，既避免了传统鼻咽内镜检查的侵入性操作，又可以多角度观察腺样体情况及其与咽鼓管圆枕的关系，仿真内镜下的腺样体形态分型对于围术期准备有指导意义。Abstract: Objective To discuss the application of virtual endoscopy in the diagnosis of adenoid hypertrophy and the morphologic classification of adenoid.Methods The clinical data of 97 children with adenoid hypertrophy admitted to Department of Otorhinolaryngology Head and Neck Surgery, Shenzhen University General Hospital from July 2022 to December 2022 were collected. The virtual endoscopic reconstruction of the nasopharynx was performed by cone beam computed tomography. The results of virtual endoscopic adenoid size measurement were compared with the results of nasopharyngeal CT median sagittal position and nasopharyngeal endoscopy. Virtual endoscopic classification of adenoid based on the size of the adenoids and their relationship with the torus tubarius.Results The t-test results of the size of adenoids measured by virtual endoscopy and nasopharyngeal CT were t=1.699 and P=0.093, and the results of intra-group correlation coefficient(ICC) analysis were ICC=0.921 and P < 0.01. The proportion of adenoids measured by virtual endoscopy and nasopharyngeal CT was highly consistent. The t-test results of the size of adenoids measured virtual endoscopy and nasopharyngeal endoscopy were t=1.543 and P=0.15, and the results of intra-group correlation coefficient(ICC) analysis were ICC=0.900 and P < 0.01. The proportion of adenoids measured by virtual endoscopy and nasopharyngeal endoscopy was highly consistent. Among the 97 children, the morphological classification results of adenoids were 48 cases of overall hypertrophy type, 47 cases of central bulge type, and 2 cases of flat thickening type.Conclusion The diagnosis of adenoid hypertrophy by virtual endoscopy has high accuracy, which not only avoids the invasive operation of traditional nasopharyngeal endoscopy, but also can observe the adenoid condition and its relationship with the torus tubarius from multiple angles. And, the morphological classification of adenoids using virtual endoscopy has guiding significance for perioperative preparation.
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Key words:
- virtual endoscopy /
- nasopharyngeal CT /
- nasopharyngeal endoscopy /
- adenoid hypertrophy
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表 1 仿真内镜A'/N'和鼻咽CT A/N，仿真内镜A'/N'和鼻咽内镜A'/N'的配对t检验
配对差值 t df Sig(双侧) X±S 标准误差平均值 差值95%CI 下限 上限 仿真内镜A'/N'-鼻咽CT A/N 0.0079±0.0455 0.0046 -0.0013 0.0170 1.699 96 0.093 仿真内镜A'/N'-鼻咽内镜A'/N' 0.0076±0.0512 0.0052 -0.0028 0.0179 1.453 96 0.150 
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表 2 组内相关系数分析
同类相关性b 95%CI 使用真值0的F检验 下限 上限 值 自由度1 自由度2 显著性 仿真内镜与鼻咽CT 单个测量 0.921a 0.884 0.946 24.714 96 96 0 平均测量 0.959 0.938 0.972 24.714 96 96 0 仿真内镜与鼻咽内镜 单个测量 0.900a 0.854 0.932 19.209 96 96 0 平均测量 0.947 0.921 0.965 19.209 96 96 0 人员效应和测量效应均随机的双向随机效应模型。a：无论是否存在交互效应，估算量均相同；b：使用绝对协议定义的A类同类相关系数。
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