Chen Xuhui, Wan Ping, Yu Yabin, Li Ming, Xu Yanyan, Huang Ping, Huang Zaoming
Department of Ear, Nose and Throat, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Voice and Swallowing Rehabilitation, Rehabilitation School, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
J Voice. 2014 Nov;28(6):799-808. doi: 10.1016/j.jvoice.2014.02.003. Epub 2014 Apr 13.
To perform a systematic literature review to evaluate the type and timing of therapy for vocal fold paresis/paralysis after thyroidectomy and develop a primary decision-making pathway.
Meta-analysis.
Four databases and one journal were searched using the key words of "thyroidectomy," "vocal cord paresis/paralysis," and "therapy." Study quality was evaluated using the Cochrane Collaboration's risk of bias tools. Data regarding type and timing of therapy were extracted from 39 articles. Odds ratios (ORs), relative risk (RR), 95% confidence interval, and heterogeneity were recorded. Logistic regression analysis was performed to determine the relationships between timing and OR/RR.
Among the 13 studies investigating unilateral paresis/paralysis, five focused on early therapy (0-6 months). In these studies, the OR for clinical heterogeneity was significantly higher after neurolysis than after injection laryngoplasty and voice training (Q = 17.002, I(2) = 78%, P = 0.000), and the RR for heterogeneity was significantly higher after injection laryngoplasty at ≥12 months than <12 months (Q = 9.984, I(2) = 89.9%, P = 0.002). In the 26 studies that investigated bilateral paresis/paralysis, the OR for heterogeneity was significantly higher for bilateral posterior cordectomy than for endolaryngeal laterofixation (Q = 3.510, I(2) = 71.5%, P = 0.061) and laser arytenoidectomy with posterior cordectomy (Q = 2.90, I(2) = 65.6%, P = 0.088).
For unilateral vocal fold paresis/paralysis after thyroidectomy, we recommend absorbable mass injection laryngoplasty, voice training, and neurolysis during the first 12 months but laryngeal reinnervation after 12 months. For bilateral vocal fold paresis/paralysis, we recommend early laterofixation and combined laser arytenoidectomy with posterior cordectomy after 12 months.
进行系统的文献综述，以评估甲状腺切除术后声带麻痹的治疗类型和时机，并制定主要的决策路径。
荟萃分析。
使用“甲状腺切除术”、“声带麻痹”和“治疗”等关键词检索四个数据库和一本期刊。使用Cochrane协作网的偏倚风险工具评估研究质量。从39篇文章中提取有关治疗类型和时机的数据。记录比值比（OR）、相对风险（RR）、95%置信区间和异质性。进行逻辑回归分析以确定时机与OR/RR之间的关系。
在13项研究单侧麻痹的研究中，有5项关注早期治疗（0 - 6个月）。在这些研究中，神经松解术后临床异质性的OR显著高于注射喉成形术和嗓音训练后（Q = 17.002，I² = 78%，P = 0.000），≥12个月时注射喉成形术后异质性的RR显著高于<12个月时（Q = 9.984，I² = 89.9%，P = 0.002）。在26项研究双侧麻痹的研究中，双侧后索切除术的异质性OR显著高于喉内外侧固定术（Q = 3.510，I² = 71.5%，P = 0.061）和激光杓状软骨切除术联合后索切除术（Q = 2.90，I² = 65.6%，P = 0.088）。
对于甲状腺切除术后单侧声带麻痹，我们建议在最初12个月内进行可吸收物质注射喉成形术、嗓音训练和神经松解术，但在12个月后进行喉再支配术。对于双侧声带麻痹，我们建议早期进行外侧固定术，并在12个月后联合激光杓状软骨切除术和后索切除术。
