Lombardi Celestino P, Raffaelli Marco, D'alatri Lucia, De Crea Carmela, Marchese Maria Raffaella, Maccora Daria, Paludetti Gaetano, Bellantone Rocco
Division of Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy.
World J Surg. 2008 May;32(5):693-700. doi: 10.1007/s00268-007-9443-2.
Voice and swallowing symptoms are frequently reported after thyroidectomy even in absence of objective voice alterations. We evaluated the influence of the video-assisted approach on voice and swallowing outcome of thyroidectomy.
Sixty-five patients undergoing total thyroidectomy (TT) were recruited. Eligibility criteria were: nodule size<or=30 mm, thyroid volume<or=30 ml, no previous neck surgery. Exclusion criteria were: younger than aged 18 years and older than aged 75 years, vocal fold paralysis, history of voice, laryngeal or pulmonary diseases, malignancy other than papillary thyroid carcinoma. Patients were randomized for video-assisted (VAT) or conventional (CT) thyroidectomy. Videostrobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) evaluation were performed preoperatively and 3 months after TT. Subjective evaluation of voice (voice impairment score=VIS) and swallowing (swallowing impairment score=SIS) were obtained preoperatively, 1 week, 1 month, and 3 months after TT.
Fifty-three patients completed the postoperative evaluation: 29 in the VAT group, and 24 in the CT group. No laryngeal nerves injury was shown at postoperative VSL. Mean postoperative MPT, F0, Flow, Fhigh, and the number of semitones were significantly reduced in the CT group but not in the VAT group. Mean VIS 3 months after surgery was significantly higher than preoperatively in CT group but not in the VAT group. Mean SIS was significantly decreased 1 and 3 months after VAT but not after CT.
The incidence and the severity of early voice and swallowing postthyroidectomy symptoms are significantly reduced in patients who undergo VAT compared with conventional surgery.
即使在没有客观声音改变的情况下，甲状腺切除术后也经常报告有声音和吞咽症状。我们评估了视频辅助手术方法对甲状腺切除术后声音和吞咽结果的影响。
招募了65例行全甲状腺切除术（TT）的患者。纳入标准为：结节大小≤30mm，甲状腺体积≤30ml，既往无颈部手术史。排除标准为：年龄小于18岁或大于75岁、声带麻痹、有声音、喉部或肺部疾病史、除甲状腺乳头状癌以外的恶性肿瘤。患者被随机分为视频辅助（VAT）或传统（CT）甲状腺切除术。术前及TT术后3个月进行视频频闪喉镜检查（VSL）、声学语音分析（AVA）和最长发声时间（MPT）评估。术前、TT术后1周、1个月和3个月进行声音的主观评估（声音损伤评分=VIS）和吞咽评估（吞咽损伤评分=SIS）。
53例患者完成了术后评估：VAT组29例，CT组24例。术后VSL未显示喉返神经损伤。CT组术后平均MPT、F0、流量、高音F及半音数量显著降低，而VAT组未降低。CT组术后3个月的平均VIS显著高于术前，而VAT组则不然。VAT术后1个月和3个月时平均SIS显著降低，而CT术后未降低。
与传统手术相比，接受VAT的患者甲状腺切除术后早期声音和吞咽症状的发生率及严重程度显著降低。
