Li Wen-Hua, Zheng Wei-Hui, Zhao Jian-Qiang, Wang Ke-Jing, Han Chun
Graduate School of Wenzhou Medical University, Wengzhou, China.
Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China.
Ear Nose Throat J. 2025 May;104(5):310-317. doi: 10.1177/01455613221115137. Epub 2022 Jul 20.
BackgroundThe performance of thyroidectomies has been increasing over the last decade due to the growing prevalence of thyroid diseases. The purpose of this study was to investigate the clinical significance of preoperative vocal cord paralysis (VCP) associated with thyroid disease and other incidences of malignant or benign lesions, as well as different thyroid pathological features. Additionally, the epidemiological changes of thyroid diseases with preoperative VCP were investigated.MethodsNinety-nine out of 12,530 patients with preoperative VCP who had undergone thyroid surgery for various diseases in the Zhejiang Cancer Hospital from January 2007 to December 2015 were identified. Their clinicopathological data was recorded and case distributions from different years and intraoperative recurrent laryngeal nerve statuses were retrospectively analyzed.ResultsThe incidence of preoperative VCP in 2007 was reported to be 1.53% (9/590) and had decreased to 0.53% (12/2,247) by 2015 ( < 0.05). Among the 99 patients with preoperative VCP, 81 had malignancies (81.82%), while 18 (18.18%) had benign thyroid diseases. The incidences of preoperative VCP in malignant and benign diseases were 1.13% (81/7,159) and 0.35% (18/5,371), respectively ( < 0.05). There were only 5 (0.04%, 5/12,530) cases of papillary thyroid microcarcinoma with preoperative VCP. There was no statistical difference between the incidence of preoperative hoarseness in malignant 69.14% (56/81) and benign diseases 61.11% (11/18) with preoperative VCP.ConclusionsThe preoperative VCP incidence rate had gradually decreased with an increased proportion of papillary thyroid cancer. Preoperative voice symptoms do not necessarily suggest a malignancy. Selective rather than routine preoperative laryngoscopic examinations should be performed on papillary thyroid microcarcinomas. The probability of preoperative VCP in malignancy was significantly higher than in benign lesions.
背景
在过去十年中，由于甲状腺疾病患病率的不断上升，甲状腺切除术的实施数量一直在增加。本研究的目的是探讨术前声带麻痹（VCP）与甲状腺疾病以及其他恶性或良性病变的发生率和不同甲状腺病理特征之间的临床意义。此外，还研究了术前VCP患者甲状腺疾病的流行病学变化。
方法
确定了2007年1月至2015年12月期间在浙江省肿瘤医院因各种疾病接受甲状腺手术的12530例术前VCP患者中的99例。记录他们的临床病理数据，并回顾性分析不同年份的病例分布和术中喉返神经状态。
结果
2007年术前VCP的发生率据报道为1.53%（9/590），到2015年已降至0.53%（12/2247）（<0.05）。在99例术前VCP患者中，81例患有恶性肿瘤（81.82%），而18例（18.18%）患有良性甲状腺疾病。恶性和良性疾病中术前VCP的发生率分别为1.13%（81/7159）和0.35%（18/5371）（<0.05）。仅有5例（0.04%，5/12530）术前VCP的甲状腺微小乳头状癌病例。术前VCP的恶性疾病患者中声音嘶哑发生率为69.14%（56/81），良性疾病患者中为61.11%（11/18），两者之间无统计学差异。
结论
随着甲状腺乳头状癌比例的增加，术前VCP发生率逐渐下降。术前声音症状不一定提示恶性肿瘤。对于甲状腺微小乳头状癌，应进行选择性而非常规的术前喉镜检查。恶性肿瘤术前VCP的概率显著高于良性病变。
