甲状腺切除术后患者嗓音声学分析动态观察

Voice Acoustic Analysis in Parients Underwent Thyroidectomy

目的动态分析甲状腺切除术后患者的嗓音变化,探讨该手术对患者发声功能的影响。方法甲状腺切除术患者48例(实验组,甲状腺腺叶及峡部切除术34例、甲状腺全切术14例)、颈部非甲状腺手术患者19例(对照组)于术前1天、术后1、2、3、7、30天分别行电子喉镜检查及嗓音声学分析,分析两组嗓音基频(F0)、基频标准差(F0TD)、基频微扰(jitter)、振幅微扰(shimmer)及信噪比(HNR)的动态变化特点。结果实验组和对照组术前、术后无声带麻痹和环杓关节脱位。实验组男性患者术后1天F0TD值高于术前1天及术后30天(P<0.05);女性患者术后1天F0值显著低于术前1天和术后2、7、30天(P<0.05),术后30天jitter值显著低于术后1天,术后1、2、3、7天F0TD值较术前显著升高,术后30天F0TD值较术后1天显著降低,术后30天HNR值较术后3天显著降低(P<0.05)。实验组男性患者手术前后各嗓音声学分析指标与对照组比较差异无统计学意义(P>0.05);实验组女性患者术前、术后1、2、3、7天F0值较对照组显著降低,术后1天jitter值、shimmer值较对照组显著升高,HNR值较对照组降低(均为P<0.05),但术后30天各项指标均与对照组女性差异无统计学意义(P>0.05)。结论无喉返神经损伤的甲状腺切除术后患者存在一定程度的嗓音声学分析指标异常,以女性患者明显,术后第30天开始好转。

Objective To study the dynamic changes and potential impacts on the voice in postoperative pa- tients with different types of thyroid operation. Methods A total of 48 cases thyroidectomy, 34 with thyroid isth- mus and lobectomy and 4 with total thyroidectomy, and 19 cases neck operation were included in this study for the examinations of electric laryngoscope, and acoustic voice analysis preoperative and postoperative, respectively. The characteristics of the acoustic parameters were analyzed. Results Vocal cord paralysis and cricothyroid joint disloca- tion in all the patients before and after operation were not observed. For male patients in the experimental group, postoperative parameter values of FOTD were higher than the day before surgery and 30 days after thyroidectomy. The difference was statistically significant （P~ 0. 05）. In female patients, postoperative parameter values of F0 were lower than the day before surgery and 2nd, 7th, and30th day after thyroidectomy. Postoperative parameter values of Jitter for 30th day were lower than 1st day after the operation. The postoperative parameter values of FOTD for 1st, 2nd, 3rd, and 7th day were higher than the day before thyroidectomy. The parameter value of FOTD was lower than 1st day after surgery, and the postoperative parameter value of HNR for 30th day was lower than 3rd day after the thyroidectomy. The difference was statistically significant （P〈0.05）. Compared to the control group, there were no significantly differences in male patients of experimental group before and after the surgery（P〉0.05）. The parameter values of F0 in famale patients before the thyroidectomy, the 1st, 2nd, 3rd, 7th day after the surgery and the parameter value of Jitter, Shimmer, HNR for 1st day after the operation were significantly dif- ferent（P〈0.05）. There were no significant differences in all parameter value of 30 days after thyoidectomy（P〉0. 05）. Conclusion Voice parameter values alter in a way after thyroid surgery without apparent recurrent laryngeal nerve injury, especially in the female patients. The improvement of voice acoustic parameters can be observed on the 30th day after operation.