边缘性腭咽闭合不全临床诊断方法的初步探索及可靠性分析

doi:10.7518/hxkq.2025.2024425

华西口腔医学杂志 ›› 2025, Vol. 43 ›› Issue (3): 376-382.doi: 10.7518/hxkq.2025.2024425

边缘性腭咽闭合不全临床诊断方法的初步探索及可靠性分析

黄欣怡(), 毛奇蓉, 尹恒, 吴敏, 石冰, 郑谦, 李精韬()

口腔疾病防治全国重点实验室国家口腔医学中心国家口腔疾病临床医学研究中心四川大学华西口腔医院唇腭裂外科，成都 610041

收稿日期:2024-11-22 修回日期:2025-03-20 出版日期:2025-06-01 发布日期:2025-06-10
通讯作者: 李精韬 E-mail:xinyihwang@163.com;lijingtao86@163.com
作者简介:黄欣怡，医师，学士，E-mail：xinyihwang@163.com
基金资助:
四川大学华西口腔医院探索与研发项目(LCYJ2022-YF-2);四川省医学青年创新科研课题计划(Q23038);四川省自然科学基金项目(2025ZNSFSC0769)

Preliminary exploration and reliability analysis of clinical diagnostic method for marginal velopharyngeal insufficiency

Huang Xinyi(), Mao Qirong, Yin Heng, Wu Min, Shi Bing, Zheng Qian, Li Jingtao()

State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China Supported by: Research and Development Program of West China Hospital of Stomatology, Sichuan University (LCYJ-2022-YF-2); Sichuan Medical Youth Innovation Research Project (Q23038); Natural Science Foundation of Sichuan Province (2025ZNSFSC0769 )

Received:2024-11-22 Revised:2025-03-20 Online:2025-06-01 Published:2025-06-10
Contact: Li Jingtao E-mail:xinyihwang@163.com;lijingtao86@163.com

摘要/Abstract

摘要：

目的针对边缘性腭咽闭合不全（MVPI）缺乏统一诊断标准的问题，探索较为可靠的临床诊断方法。方法收集腭裂术后患者的鼻咽纤维镜检查和语音评估结果，分析不同腭咽闭合度下鼻腔共鸣情况分布的差异及二者的相关性。以轻/中度高鼻音及对应的腭咽闭合度建立MVPI的诊断标准，并验证该标准的可重复性及有效性。结果腭咽闭合度与鼻腔共鸣情况较强相关（P<0.001）。轻/中度高鼻音主要对应的腭咽闭合度为90%~99%，二者结合作为MVPI诊断标准具备良好的一致性（Kappa值为0.789，P<0.001），且该标准下腭咽闭合不全与MVPI患者的鼻腔共鸣（P<0.001）、鼻漏气（P=0.007）及构音错误（P<0.001）分布差异均存在统计学意义。结论结合主观判听轻/中度高鼻音和鼻咽纤维镜下高于90%的腭咽闭合度是诊断MVPI可靠有效的临床方法。

关键词: 腭咽闭合不全, 诊断, 腭裂, 构音

Abstract:

Objective A stable, reliable, and easily implementable clinical diagnostic method for marginal velopharyngeal insufficiency (MVPI) was established on the basis of the subjective hearing judgement of hypernasality and objective examination of velopharyngeal closure to address the lack of unified diagnostic criteria for MVPI. Methods Nasopharyngeal fiberscopy and speech assessment results were collected from postoperative patients with cleft palate. These results were used to analyze the differences in the distribution of nasal resonance in patients with different velopharyngeal closure ratios and the correlation between velopharyngeal closure ratios and nasal resonance status. Mild-to-moderate hypernasality with its corresponding elopharyngeal closure ratio was employed to establish the diagnostic criteria of MVPI. The reproducibility of the criteria and whether the patients with MVPI diagnosed by using the criteria exhibited significantly different speech characteristics compared with other patients were verified. Results A strong correlation was found between velopharyngeal closure ratios and nasal resonance (P<0.001). Mild-to-moderate hypernasality mainly corresponded to velopharyngeal closure ratios ranging from 90% to 99%, and the combination of the two characteristics as the diagnostic criteria for MVPI demonstrated good consistency (Kappa value=0.789, P<0.001). Moreover, under the diagnostic criteria, significant differences in nasal resonance (P<0.001), nasal emission (P=0.007), and misarticulation (P<0.001) were found between patients with velopharyngeal insufficiency and those with MVPI. Conclusion Combining the subjective hearing judgement of mild-to-moderate hypernasality with velopharyngeal closure ratios over 90% under nasopharyngeal fiberscopy provides a reliable and effective clinical method for diagnosing MVPI.

Key words: velopharyngeal insufficiency, diagnosis, cleft palate, articulation

中图分类号:

R782.2^＋2

黄欣怡, 毛奇蓉, 尹恒, 吴敏, 石冰, 郑谦, 李精韬. 边缘性腭咽闭合不全临床诊断方法的初步探索及可靠性分析[J]. 华西口腔医学杂志, 2025, 43(3): 376-382.

Huang Xinyi, Mao Qirong, Yin Heng, Wu Min, Shi Bing, Zheng Qian, Li Jingtao. Preliminary exploration and reliability analysis of clinical diagnostic method for marginal velopharyngeal insufficiency[J]. West China Journal of Stomatology, 2025, 43(3): 376-382.

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VCR/%	例数	比例/%
100	640	26.92
90~99	474	19.94
80~89	350	14.72
70~79	168	7.07
<70	745	31.34

鼻腔共鸣状态	例数	比例/%
无高鼻音	498	20.95
轻度高鼻音	428	18.01
中度高鼻音	237	9.97
重度高鼻音	1 214	51.07

鼻腔共鸣状态	VCR
鼻腔共鸣状态	100% （n=640）	90%~99% （n=474）	80%~89% （n=350）	70%~79% （n=168）	<70% （n=745）
无高鼻音	498/77.8	0/0	0/0	0/0	0/0
轻度高鼻音	135/21.1	291/61.4	2/0.6	0/0	0/0
中度高鼻音	5/0.8	101/21.3	90/25.7	35/20.8	6/0.8
重度高鼻音	2/0.3	82/17.3	258/73.7	133/79.2	739/99.2

VCR	两两比较的P值*
VCR	100%	90%~99%	80%~89%	70%~79%	<70%
100%	-	<0.001	<0.001	<0.001	<0.001
90%~99%	-	-	<0.001	<0.001	<0.001
80%~89%	-	-	-	1.000	<0.001
70%~79%	-	-	-	-	0.072

第一次评价	第二次评价			合计
第一次评价	VPI	MVPI	VPC	合计
合计	132	118	134	384
VPI	120	8	0	128
MVPI	12	96	20	128
VPC	0	14	114	128

边缘性腭咽闭合不全临床诊断方法的初步探索及可靠性分析

Preliminary exploration and reliability analysis of clinical diagnostic method for marginal velopharyngeal insufficiency

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参考文献 32

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项目	VPI	MVPI	P值
鼻腔共鸣			<0.001
无高鼻音	0	0
轻度高鼻音	0	108
中度高鼻音	16	20
重度高鼻音	112	0
鼻漏气			0.007
未闻及	0	8
可闻及	128	120
构音错误			<0.001
正常	0	0
省略	16	42
代偿	38	76
多种错误	74	10

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