甲状腺全切手术患者术前与术后嗓音功能对比研究

A cmparative study of the voice function change in patients who underwent total thyroidectomy between preoperative and postoperative

目的:观察甲状腺全切手术患者术前与术后第3天的嗓音功能变化,探讨甲状腺手术患者嗓音保护的方法。方法:对353例术前无嗓音障碍的甲状腺乳头状癌患者实施甲状腺全切及单或双侧中央区颈部淋巴结清扫术,分别于术前和术后第3天行频闪喉镜检查、嗓音障碍指数10量表(VHI-10)评估,根据检查结果对患者的声音行客观声学分析。结果:353例患者术后自诉有嗓音症状的有294例(83.29%),其中声嘶105例(35.71%),发声无力78例(26.53%),不能大声说话53例(18.03%),不能发高声24例(8.16%),不能发低声29例(9.86%),发声漏气5例(1.70%)。所有患者术后频闪喉镜检查示声带运动正常。术后第3天与术前比较,VHI-10总分及生理、情感2个维度均升高(P<0.05)。客观声学评估中,男性甲状腺手术患者术后第3天与术前比较,基频(F0)、谐波噪声比(HNR)、最长发声时间(MPT)均降低,基频振幅(Shimmer)升高(P<0.05),女性患者术后第3天与术前相比,F0、基频微扰、HNR、MPT均降低,Shimmer升高(P<0.05)。结论:接受甲状腺全切及单或双侧中央区颈部淋巴结清扫术的患者,即使术中未损伤喉返神经,术后也可出现不同程度的嗓音症状。手术及嗓音的改变可能会使患者的心理发生改变,提示临床医生术前需做好充分的医患沟通,术后关注患者的嗓音质量及心理变化,并给予积极的干预。

Objective:The aim of this study is to investigate the voice function change in patients who underwent total thyroidectomy between preoperative and the third day postoperative,Taking the result data to explore methods for voice protection and be valuable for clinical diagnose and treatment.Method:Three hundred and fifththree patients with thyroid papillary carcinoma without preoperative vocal dysfunction were treated with total thyroidectomy and single or bilateral central cervical lymph node dissection.At preoperative and the third day postoperative,videostroboscopic,acoustic analysis,voice handicap index 10(VHI-10)are measured.Result:At the third day postoperative,294(83.29%)patients have voice symptoms,the most common voice disorder is hoarseness in105 cases(35.71%),phonasthenia in 78 cases(26.53%),unable speak louderly in 53 cases(18.03%),unable speak high-pitch in 24 cases(8.16%),unable speak low-pitch in 29 cases(9.86%),pronunciation leakage in 5 cases(1.70%).Videostroboscopic examinations are normal in all patients at the third day postoperative.The total score of VHI-10,Physiology(P),Emotion(E)dimensions in VHI-10 between preoperative and the third day postoperative are statistically significant(P<0.05).For male patients,the acoustic analysis(fundamental frequency,Harmonicto Noise Ratio,Shimmer and Maximum phonation time)are statistically significant between preoperative and the third day postoperative(P<0.05).For female patients,acoustic analysis(fundamental frequency,Harmonicto Noise Ratio,Shimmer,Jitter and Maximum phonation time)are statistically significant between preoperative and the third day postoperative(P<0.05).Conclusion:These patients who underwent total thyroidectomy with bilateral or unilateral central partment lymph node dissection may develop voice complications even their recurrent laryngealnerve be undamaged during the surgery.Changes in surgery and voice may cause changes in the patient’s psychology,suggesting that clinicians need to have adequate communication between doctors and patients before surgery,pay attention to the patient’s voice quality and psychological changes,and give positive intervention.