Sun D Y, Zhang X S, Gao R G, Li K, Feng B H, Wang M S, He W
Department of General Surgery, the Second People's Hospital of Qujing, Qujing, 655000, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Jul 5;31(13):998-1002. doi: 10.13201/j.issn.1001-1781.2017.13.007.
To investigate the changes of speech and voice acoustics in patients with thyroid disease before and after operation, get objective values, and conducive to guiding the clinical diagnosis and treatment and recurrent laryngeal nerve protection. A total of 216 patients undergoing thyroid surgery from October 2015 to October 2016 were treated with TVQ and GRBAS at 1 day before surgery, 1 week, 1 month, and 3 months postoperatively to phonological assessment, and Praat software was used to collect and analyze the acoustic acoustics index for preoperative and postoperative comparative analysis. All patients did not damage the recurrent laryngeal nerve, unilateral or bilateral thyroid subtotal resection (no exploration of recurrent laryngeal nerve) in patients with postoperative speech and voice index F0 was decreased at 1 week after surgery (<0.05), the other indicators did not change significantly; difference was found out in single-sided total thyroidectomy+ipsilateral central area lymph node dissection, bilateral thyroidectomy+unilateral central area lymph node dissection (exploration of unilateral recurrent laryngeal nerve) in patients with TVQ, GRBAS and F0, HNR after surgery 1 week compared with preoperative (<0.05), However, there was no significant difference 3 months; TVQ, GRBAS and F0, HNR were significantly changed in patients with bilateral thyroidectomy+bilateral central lymph node dissection (revealed bilateral recurrent laryngeal nerve) at 1 week after operation (>0.05). F0 and HNR were lower than those before operation, and the patients were treated with Jitter and Shimmer. The patients were treated with TVQ, GRBAS, Jitter and Shimmer before operation, however, the majority of patients' TVQ, GRBAS, Jitter, Shimmer can be restored to preoperative level after surgery 3 months (>0.05). The appearance of speech and voice problems in patients after thyroid surgery may increase with the expansion of the surgical range, the change in speech and voice after neck lymph node dissection is reversible.
为探讨甲状腺疾病患者手术前后言语和嗓音声学变化，获取客观指标，以利于指导临床诊疗及保护喉返神经。选取2015年10月至2016年10月行甲状腺手术的216例患者，于术前1天、术后1周、1个月及3个月采用嗓音质量主观评估（TVQ）和GRBAS评估法进行语音学评估，并用Praat软件采集分析声学指标进行术前术后对比分析。所有患者均未损伤喉返神经，行单侧或双侧甲状腺次全切除术（未探查喉返神经）的患者术后1周语音和嗓音指标F0降低（<0.05），其他指标无明显变化；单侧甲状腺全切除术+同侧中央区淋巴结清扫术、双侧甲状腺切除术+单侧中央区淋巴结清扫术（探查单侧喉返神经）患者术后1周TVQ、GRBAS及F0、HNR与术前比较差异有统计学意义（<0.05），但3个月时无明显差异；双侧甲状腺切除术+双侧中央区淋巴结清扫术（显露双侧喉返神经）患者术后1周TVQ、GRBAS及F0、HNR变化有统计学意义（>0.05），F0和HNR低于术前，且伴有基频微扰（Jitter）和振幅微扰（Shimmer）。术前采用TVQ、GRBAS、Jitter和Shimmer评估患者，术后3个月多数患者TVQ、GRBAS、Jitter、Shimmer可恢复至术前水平（>0.05）。甲状腺手术后患者言语和嗓音问题的出现可能随手术范围扩大而增加，颈部淋巴结清扫术后言语和嗓音变化具有可逆性。
