Park Min Woo, Baek Seung-Kuk, Park Euy-Hyun, Jung Kwang-Yoon
Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Auris Nasus Larynx. 2018 Jun;45(3):527-532. doi: 10.1016/j.anl.2017.08.007. Epub 2017 Aug 30.
Voice dysfunction is frequently reported after thyroidectomy even in absence of vocal fold paralysis. The energy-based devices such as Harmonic scalpel (HS) or LigaSure (LS) are commonly used in conventional thyroidectomy. The objective of this study was to investigate the long-term voice outcome after total thyroidectomy using energy based devices.
Patients who underwent total thyroidectomy with or without central neck dissection for papillary thyroid carcinoma using HS or LS from April 2012 to March 2013 were involved. The videolaryngostroboscopy, acoustic analysis, voice range profile, voice perceptual evaluation, and voice handicap index-30 were obtained preoperatively, 1 week, 1 month, 3 months, 6 months, and 1year after thyroidectomy.
Total 92 patients (HS group: 58 cases; LS group: 34 cases) were enrolled in this study. Demographics, tumor stage, and extent of operation were not significantly different between the HS and LS group. None of the patients evidenced any abnormalities at the pre- or postoperative videolaryngostroboscopic examination. The voice range profile (highest frequency), voice perceptual evaluation (grade, rough, and breathy), and voice handicap index-30 (total, functional, physical, and emotional) showed significantly worse scores in early postoperative period (<1month), but gradually returned to preoperative values. The all parameters of acoustic analysis, voice range profile, voice perceptual evaluation, and voice handicap index-30 were not significantly different between the HS and LS group.
The long-term voice change after thyroidectomy shows similar results regardless of the type of energy-based devices.
即使在没有声带麻痹的情况下，甲状腺切除术后也经常报告有声带功能障碍。诸如谐波手术刀（HS）或血管闭合系统（LS）等基于能量的设备常用于传统甲状腺切除术。本研究的目的是调查使用基于能量的设备进行全甲状腺切除术后的长期声音结果。
纳入2012年4月至2013年3月期间使用HS或LS进行全甲状腺切除术（无论是否进行中央颈淋巴结清扫）治疗甲状腺乳头状癌的患者。在甲状腺切除术前、术后1周、1个月、3个月、6个月和1年进行视频喉镜频闪检查、声学分析、嗓音音域分析、嗓音感知评估和嗓音障碍指数-30评估。
本研究共纳入92例患者（HS组：58例；LS组：34例）。HS组和LS组在人口统计学、肿瘤分期和手术范围方面无显著差异。术前或术后视频喉镜频闪检查均未发现任何患者有异常。嗓音音域分析（最高频率）、嗓音感知评估（分级、粗糙和呼吸音）和嗓音障碍指数-30（总分、功能、身体和情感）在术后早期（<1个月）显示明显较差的评分，但逐渐恢复到术前值。HS组和LS组在声学分析、嗓音音域分析、嗓音感知评估和嗓音障碍指数-30的所有参数方面无显著差异。
无论使用何种基于能量的设备，甲状腺切除术后的长期声音变化结果相似。
