Wong Kai-Pun, Au Kin Pan, Lam Shi, Chang Yuk Kwan, Lang Brian Hung Hin
Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China.
World J Surg. 2019 Mar;43(3):824-830. doi: 10.1007/s00268-018-4826-0.
Transcutaneous laryngeal ultrasound (TLUSG) is an innovative, non-invasive tool in detecting post-thyroidectomy vocal cord palsy (VCP). However, TLUSG failed to detect about 6-15% laryngoscopic examination (LE)-confirmed VCP. It is unclear whether the outcome of patients with VCP missed by TLUSG [false negative (FN)] is different from those with VCP diagnosed by TLUSG [true positive (TP)]. Therefore, this study aimed to compare the clinical outcome and prognosis between patients with FN results and TP results.
Over 46 months, all consecutive patients undergoing thyroidectomy or endocrine-related neck procedure were recruited. They underwent pre-operative and post-operative voice assessments on symptoms, voice-specific questionnaire [voice handicap index questionnaire (VHI-30)], TLUSG and LE. For patients with post-operative vocal cord palsy, reassessment LE would be arranged at second, fourth, sixth and twelfth months post-operatively until VCP recovered.
In total, 1196 patients, including 74 post-thyroidectomy VCP, were recruited. For those with assessable vocal cords (VC), 58 VCP were correctly diagnosed by TLUSG (TP) and 10 VCP were missed by TLUSG (FN). Sensitivity and specificity of detecting a VCP by TLUSG were 85.3% and 94.7%, respectively. VHI-30 score was significantly increased after operation in TP group [31 (range - 6-105), p < 0.001] but not in FN group [20 (14-99), p = 0.089]. Comparing to TP group, VCP recovered earlier (69 vs. 125 days, p < 0.001) and less patients suffered from permanent VCP in patients with FN results. (34.5% vs. 0.0%, p = 0.027).
The VCP missed by TLUSG had a milder course of disease. Early recovery of VC function and non-permanent palsy were expected.
经皮喉超声（TLUSG）是一种用于检测甲状腺切除术后声带麻痹（VCP）的创新型非侵入性工具。然而，TLUSG未能检测出约6%-15%经喉镜检查（LE）确诊的VCP。目前尚不清楚TLUSG漏诊的VCP患者[假阴性（FN）]的预后是否与TLUSG确诊的VCP患者[真阳性（TP）]不同。因此，本研究旨在比较FN结果患者和TP结果患者的临床结局和预后。
在46个月的时间里，招募了所有连续接受甲状腺切除术或内分泌相关颈部手术的患者。他们在术前和术后接受了关于症状、语音特异性问卷[嗓音障碍指数问卷（VHI-30）]、TLUSG和LE的嗓音评估。对于术后声带麻痹的患者，将在术后第2、4、6和12个月安排复查LE，直至VCP恢复。
总共招募了1196例患者，其中包括74例甲状腺切除术后VCP患者。对于那些声带（VC）可评估的患者，TLUSG正确诊断出58例VCP（TP），TLUSG漏诊10例VCP（FN）。TLUSG检测VCP的敏感性和特异性分别为85.3%和94.7%。TP组术后VHI-30评分显著升高[31（范围-6-105），p<0.001]，而FN组未升高[20（14-99），p=0.089]。与TP组相比，FN结果患者的VCP恢复更早（69天对125天，p<0.001），且永久性VCP患者更少（34.5%对0.0%，p=0.027）。
TLUSG漏诊的VCP病程较轻。预计VC功能可早期恢复且不会出现永久性麻痹。
