Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Hospital, Korea University College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2013 Nov;20(12):3869-76. doi: 10.1245/s10434-013-3163-7. Epub 2013 Aug 2.
After open thyroidectomy, patients usually complain of voice, sensory, and swallowing symptoms. We approached the thyroid via the subfascial method to reduce these symptoms and compared postthyroidectomy symptoms with the conventional subplatysmal method.
Eighty-six patients undergoing thyroidectomy were recruited and randomized into either a conventional subplatysmal approach group (subplatysmal, 42 patients) group or a subanterior fascia of strap muscle approach group (subfascial, 44 patients). Voice symptoms were assessed using the Voice Handicap Index questionnaire and acoustic voice analysis. Sensory alterations were evaluated by the light touch and pain touch methods. Swallowing symptoms were assessed using the Swallowing Impairment Score (SIS) questionnaire, barium swallowing time, and hyoid bone movement range. Each variable was measured preoperatively, and at 2 weeks and 3 months after thyroidectomy.
In both groups, the subjective symptoms of voice, sensation, and swallowing were significantly worsened at 2 weeks after operation, but improved 3 months after operation. Patients in the subplatysmal group had worse SIS scores than patients in the subfascial group (p = 0.016) and delayed barium swallowing time 2 weeks after operation (p = 0.008 compared to preoperative level). In the cohort over 50 years of age, SIS score did not recover to preoperative levels in the subplatysmal group 3 months after operation (p = 0.005 compared to preoperative level).
The subfascial approach may be an effective method for reducing postthyroidectomy swallowing symptoms based on swallowing impairment score, especially in patients over 50 years of age.
甲状腺开放手术后，患者通常会出现声音、感觉和吞咽症状。我们采用筋膜下方法接近甲状腺，以减少这些症状，并将术后症状与传统的皮下方法进行比较。
招募了 86 例行甲状腺切除术的患者，并随机分为传统皮下入路组（皮下组，42 例）或前筋膜颈阔肌入路组（筋膜下组，44 例）。采用嗓音障碍指数问卷和声学嗓音分析评估嗓音症状。通过轻触和痛觉评估感觉改变。采用吞咽障碍评分（SIS）问卷、钡吞咽时间和舌骨运动范围评估吞咽症状。每个变量在术前、术后 2 周和 3 个月进行测量。
两组患者术后 2 周时声音、感觉和吞咽的主观症状均明显恶化，但术后 3 个月时有所改善。皮下组患者的 SIS 评分较筋膜下组患者差（p = 0.016），术后 2 周钡吞咽时间延长（p = 0.008 与术前相比）。在年龄超过 50 岁的患者中，皮下组患者术后 3 个月时 SIS 评分未恢复到术前水平（p = 0.005 与术前相比）。
筋膜下入路可能是一种有效减少甲状腺切除术后吞咽症状的方法，特别是在年龄超过 50 岁的患者中。
