甲状腺部分或全切除术后患者的嗓音主客观检测结果分析

Analysis of Subjective and Objective Voice Analysis after Partial or Total Thyroidectomy

赵瑞敏;黄健华;朱云;曹亚莉;李宏慧;李化静;张婷;

1:西安交通大学第一附属医院耳鼻咽喉头颈外科

摘要

目的探讨行甲状腺切除手术对患者嗓音的影响。方法以2017年1月～2017年8月行甲状腺部分或全切除手术患者325例为研究对象,按手术方式分为4组,1组(81例)行甲状腺单侧叶切除术,2组(51例)行甲状腺单侧叶切除+中央区淋巴结清扫术,3组(40例)行甲状腺近全切或全切术,4组(153例)行甲状腺全切+中央区淋巴结清扫术。所有患者在术前1天、术后1周及1月使用嗓音障碍指数问卷(VHI)及GRBAS分级法进行嗓音评估,并应用计算机嗓音分析软件(XiON)进行嗓音声学分析,以频闪喉镜检查评估声带状态,对术前、术后的结果进行对比分析。结果所有患者术中均探查暴露喉返神经,术后频闪喉镜提示4组中有5例患者发生单侧声带麻痹,4组中2例、3组中1例患者发生单侧喉上神经功能损伤,该8例患者术后1月所有嗓音检测指标均未恢复正常。其余317例未发生声带麻痹的患者嗓音声学分析结果显示:1组患者术前、术后各项指标对比无明显差异(P>0.05);2组及3组患者术后1周VHI评分、GRBAS分级异常例数较术前均上升、F0均降低(均为P<0.05),而其余指标手术前后均无明显差异(P>0.05),术后1月各项指标与术前对比无明显差异(P>0.05);4组患者术后1周VHI评分及GRBAS分级异常例数较术前增多,F0较术前降低,基频微扰及振幅微扰较术前升高,最长发声时间较术前缩短,差异有统计学意义(P<0.05),术后1月各项指标均恢复正常。结论甲状腺手术后患者的语音及嗓音异常的出现可能随手术范围的扩大、肿瘤的侵犯、喉返神经的暴露增加而增加,而无神经损伤者的语音及嗓音异常是可逆的。

关键词

甲状腺手术;嗓音异常;嗓音分析

基金项目(Foundation):

作者

赵瑞敏;黄健华;朱云;曹亚莉;李宏慧;李化静;张婷;

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甲状腺手术嗓音异常嗓音分析

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赵瑞敏黄健华朱云曹亚莉李宏慧李化静张婷