甲状腺手术患者的语音评估及嗓音分析

Phonological assessment and voice analysis of thyroid surgery patients

目的:探讨甲状腺疾病患者手术前后的语音评估及嗓音声学指标变化,获取客观数值,指导临床诊治及对喉返神经的保护。方法:对2015-10-2016-10期间收治的216例甲状腺手术患者在术前1d及术后1周、1个月、3个月使用甲状腺切除术相关语音问卷(TVQ)及日本言语语音协会嗓音GRBAS分级法进行语音评估,并利用Praat软件采集分析嗓音声学指标,进行术前、术后的对比分析。结果:所有入组患者均未损伤喉返神经,单侧或双侧甲状腺次全切除术(未探查喉返神经)患者术后语音及嗓音声学指标除术后1周时F0降低(P<0.05)外,其余指标变化不明显;单侧甲状腺全切除加同侧中央区淋巴结清扫、双侧甲状腺全切除加单侧中央区淋巴结清扫(探查单侧喉返神经)患者的语音主观评估TVQ、GRBAS及声学指标F0、HNR在术后1周时与术前比较差异有统计学意义(P<0.05),声学指标F0、HNR在术后1个月时与术前比较仍差异有统计学意义(P<0.05),但在术后3个月时语音主观评估及声学指标与术前对比无明显差异;双侧甲状腺全切除加双侧中央区淋巴结清扫手术(显露双侧喉返神经)患者术后1周与1个月时TVQ、GRBAS与术前比较差异有统计学意义,F0、HNR显著降低,Jitter、Shimmer升高(P<0.05),但术后3个月时多数患者TVQ、GRBAS、Jitter、Shimmer可恢复至术前水平(P>0.05)。结论:甲状腺手术后患者的语音及嗓音问题的出现可能随手术范围的扩大而增加,行颈部淋巴结清扫术(未损伤喉返神经、喉上神经)后出现的语音及嗓音改变是可逆的。

Objective： To investigate the changes of speech and voice acoustics in patients with thyroid disease before and after operation, get objective values, and conducive to guiding the clinical diagnosis and treatment and recurrent laryngeal nerve protection. Method： A total of 216 patients undergoing thyroid surgery from October 2015 to October 2016 were treated with TVQ and GRBAS at 1 day before surgery, 1 week, 1 month, and 3 months postoperatively to phonological assessment, and Praat software was used to collect and analyze the acoustic acous- tics index for preoperative and postoperative comparative analysis; Result： All patients did not damage the recur- rent laryngeal nerve, unilateral or bilateral thyroid subtotal resection（no exploration of recurrent laryngeal nerve） in patients with postoperative speech and voice index F0 was decreased at 1 week after surgery（P^0.05）, the other indicators did not change significantly;difference was found out in single-sided total thyroidectomy＋ ipsilat- eral central area lymph node dissection, bilateral thyroideetomy＋ unilateral central area lymph node dissection（ex- ploration of unilateral recurrent laryngeal nerve） in patients with TVQ, GRBAS and F0, HNR after surgery i week compared with preoperative （P~ 0. 05）, However, there was no significant difference 3 months; TVQ, GRBAS and F0, HNR were significantly changed in patients with bilateral thyroidectomy＋ bilateral central lymph node dissection（revealed bilateral recurrent laryngeal nerve） at 1 week after operation（P^0.05）. F0 and HNR were lower than those before operation, and the patients were treated with Jitter and Shimmer. The patients were treated with TVQ, GRBAS, Jitter and Shimmer before operation, however, the majority of patients＇ TVQ, GRBAS, Jitter, Shimmer can be restored to preoperative level after surgery 3 months（P〉0.05）. Conclusion： The appearance of speech and voice problems in patients after thyroid surgery may increase with the expansion of the surgical range, the change in speech and voice after neck lymph node dissection is reversible.