Clinical Value Of Percutaneous Laryngeal Ultrasound Screening For Vocal Cord Paralysis In Postoperative Esophageal Cancer

OBJECTIVE: The aim of this study was to analyse the risk factors associated with vocal fold paralysis after minimally invasive radical surgery for esophageal cancer and to investigate the clinical value of using transcutaneous laryngeal ultrasonography(TLUSG)to screen for vocal fold paralysis in postoperative patients and to investigate the factors affecting the accuracy of this test with a view to further improving its accuracy.METHODS: This is a prospective study.Sixty-five patients who underwent minimally invasive radical esophageal cancer surgery and were transferred to the Intensive Care Unit(ICU)after surgery at Sichuan Cancer Hospital between December2021 and December 2022 were screened for inclusion.Thirty-nine cases were ultimately included.The clinical data for all patients were collected to compare the risk factors for the occurrence of vocal cord palsy due to laryngeal recurrent nerve injury after minimally invasive radical esophagectomy for esophageal cancer,as well as to assess the clinical value of fiberoptic bronchoscopy and ultrasonography for evaluating vocal cord palsy.According to the results of fiberoptic bronchoscopy assessment of vocal fold paralysis after radical esophagectomy for esophageal cancer,patients were divided into two groups: those with vocal fold paralysis and those with normal vocal fold movement.Furthermore,the sensitivity,specificity,positive predictive value,and negative predictive value of ultrasound for diagnosing vocal fold paralysis were evaluated.Based on the results of fiberoptic bronchoscopy and ultrasound assessment,patients were divided into true-positive,true-negative,false-positive,and false-negative groups.RESULTS: Of the 39 patients who underwent radical surgery for esophageal cancer,ultrasound and fibreoptic bronchoscopy findings were compatible in 28 cases(71.8%).Based on the results of fibreoptic bronchoscopic assessment of vocal fold paralysis after radical esophageal cancer surgery,patients were divided into the vocal fold paralysis group and the normal vocal fold movement group.The differences in the distribution of patients in the two groups in terms of pathological N stage,tumour location and preoperative chemotherapy were statistically significant(p<0.05);univariate and multifactorial analyses showed that pathological N stage and preoperative chemotherapy were independent risk factors for the development of vocal fold paralysis;using fibreoptic bronchoscopy As the gold standard for diagnosis,fibreoptic bronchoscopy was used to diagnose vocal fold paralysis in 19 cases and was negative in 20 cases.The sensitivity of ultrasound for vocal fold paralysis was 70%,the specificity was 73.7%,the accuracy was 71.8%,the positive predictive value was 73.7%and the negative predictive value was 70%.According to the results of ultrasound and fibreoptic bronchoscopy assessment of vocal cord paralysis after radical oesophageal cancer,patients were divided into the group with consistent vocal cord assessment and the group with inconsistent assessment.Between the two groups,the differences in degree of tumour differentiation,lactate were statistically significant(P<0.05);according to the results of fibreoptic bronchoscopy and ultrasound assessment,patients were divided into the true positive group,true negative group,false positive group and false negative group,with differences in age group and FEV1% between the two groups of patients(P<0.05).CONCLUSIONS: 1.The univariate analysis of variance revealed that tumor location differed between the two groups based on fiberoptic bronchoscopic grouping.Therefore,routine postoperative monitoring of vocal cord motion is recommended for patients with mid-thoracic esophagus.2.Both univariate and logistic regression analyses showed that stage N1 and preoperative chemotherapy were independent risk factors for vocal cord paralysis.3.Univariate analysis of variance showed that age grouping,FEV1% differed between the two groups of patients according to grouping based on fibreoptic bronchoscopy and ultrasound assessment.Routine postoperative ultrasound is recommended for older patients with poor preoperative lung function.4.Percutaneous laryngeal ultrasound can serve as a screening tool for postoperative vocal cord palsy in patients with esophageal cancer.