Choi Yong-Sug, Joo Young-Hoon, Park Young-Hak, Kim Sang-Yeon, Sun Dong-Il
Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea.
World J Surg. 2018 Jul;42(7):2117-2122. doi: 10.1007/s00268-017-4440-6.
We used voice analysis and clinicopathological factors to explore the prognosis of unilateral vocal fold paralysis after thyroid surgery.
The medical records of 63 females who developed unilateral vocal fold paralysis after thyroidectomy were reviewed. All patients were divided into two groups: those who recovered from vocal fold paralysis and those who did not. We analyzed clinical parameters and voice analysis results in a search for correlations with recovery from paralysis.
Of the 63 patients, 37 (58%) recovered from paralysis. A small tumor size, incomplete paralysis, the absence of arytenoid tilting, no compensatory movement of the normal side, lower postoperative shimmer, a higher postoperative maximum phonation time (MPT), and lower postoperative subglottic pressure correlated significantly with recovery from vocal fold paralysis. Multivariate analysis confirmed that the absence of compensatory movement of the normal side on videostroboscopy was independently prognostic. A postoperative MPT of 6.86 appeared to be optimal for prediction of recovery. Most patients recovered within 6 months, but those with incomplete paralysis recovered about 3 months earlier. At the 12-month follow-up, the thyroidectomy-related voice questionnaire scores had returned to preoperative values in only 12 patients (19.0%); 51 patients (81.0%) did not fully recover.
Compensatory movement of the normal side evident on videostroboscopy was a poor prognostic factor. Voice analysis can be helpful in counseling vocal fold paralysis patients after thyroidectomy, and early intervention may be considered in patients who are expected to have a poor prognosis.
我们采用嗓音分析和临床病理因素来探究甲状腺手术后单侧声带麻痹的预后情况。
回顾了63例甲状腺切除术后发生单侧声带麻痹的女性患者的病历。所有患者被分为两组：声带麻痹恢复组和未恢复组。我们分析了临床参数和嗓音分析结果，以寻找与麻痹恢复的相关性。
63例患者中，37例（58%）麻痹恢复。肿瘤体积小、不完全麻痹、无杓状软骨倾斜、健侧无代偿运动、术后颤动微扰较低、术后最大发声时间（MPT）较长以及术后声门下压力较低与声带麻痹恢复显著相关。多因素分析证实，频闪喉镜检查显示健侧无代偿运动是独立的预后因素。术后MPT为6.86似乎是预测恢复的最佳值。大多数患者在6个月内恢复，但不完全麻痹的患者恢复时间约早3个月。在12个月的随访中，仅12例患者（19.0%）的甲状腺切除相关嗓音问卷评分恢复到术前水平；51例患者（81.0%）未完全恢复。
频闪喉镜检查显示的健侧代偿运动是预后不良的因素。嗓音分析有助于对甲状腺切除术后声带麻痹患者进行咨询，对于预后可能较差的患者可考虑早期干预。
