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小鼠神经生长因子联合喉上神经外支暴露对甲状腺切除术后嗓音变化的影响:一项前瞻性非随机对照试验

Effect of mouse nerve growth factor combined with the exposure of the external branch of superior laryngeal nerve on voice changes after thyroidectomy: a prospective non-randomized controlled trial.

作者信息

Zhang Jiaoping, Zhang Wo, Peng You, Sun Li, Wang Min

机构信息

Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Department of Thyroid Surgery, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China.

出版信息

Gland Surg. 2022 Dec;11(12):1976-1983. doi: 10.21037/gs-22-703.

Abstract

BACKGROUND

The superior laryngeal nerve (SLN) injury may also affect vocal fold function and voice quality. It is efficient yet simple approach to expose the external branch of the superior laryngeal nerve (EBSLN). Neurotrophic agent mouse nerve growth factor (mNGF) to treat patients after thyroid surgery, and found it had significant efficacy in improving the voice of patients. However, the potential effectiveness and safety of mNGF combined with EBSLN were unclear.

METHODS

In this study, 96 patients who suffered from hoarseness after thyroidectomy at Hangzhou First People's Hospital between January 2018 and October 2019 were screened and divided into the control group and the observation group by patients' choice. In the control group, the SLN was not exposed. In the observation group, the SLN was exposed. The mNGF treatment was administered for observation group once a day at 20 µg each time for 4 weeks. The data of acoustic voice indicators was analysis by univariate analyses. Patients in both groups were followed up for more than 6 months. The rate of SLN damage was compared between two groups.

RESULTS

The baseline clinical characteristics of the two groups showed no statistic difference. The results showed that the fundamental frequency was significantly lower 1 month after surgery than 3 days after surgery in both groups. The fundamental frequency perturbation, shimmer, maximum phonation time, highest fundamental frequency, and dysphonia severity index in 1 month after surgery were significantly higher than they were 3 days after surgery (all P<0.001). There was no significant difference in the postoperative harmonic-to-noise ratio between the 2 groups (P=0.426).

CONCLUSIONS

MNGF combined with the exposure and protection of the EBSLN effectively may prevent voice damage after thyroid surgery.

摘要

背景

喉上神经(SLN)损伤也可能影响声带功能和嗓音质量。暴露喉上神经外支(EBSLN)是一种有效且简单的方法。用神经营养因子小鼠神经生长因子(mNGF)治疗甲状腺手术后的患者,发现其在改善患者嗓音方面有显著疗效。然而,mNGF联合EBSLN的潜在有效性和安全性尚不清楚。

方法

本研究筛选了2018年1月至2019年10月在杭州市第一人民医院甲状腺切除术后出现声音嘶哑的96例患者,由患者自行选择分为对照组和观察组。对照组不暴露SLN。观察组暴露SLN。观察组给予mNGF治疗,每次20μg,每天1次,共4周。对声学嗓音指标数据进行单因素分析。两组患者均随访6个月以上。比较两组SLN损伤发生率。

结果

两组的基线临床特征无统计学差异。结果显示,两组术后1个月的基频均显著低于术后3天。术后1个月的基频微扰、振幅微扰、最长发声时间、最高基频和嗓音障碍严重程度指数均显著高于术后3天(均P<0.001)。两组术后谐波噪声比无显著差异(P=0.426)。

结论

mNGF联合EBSLN的暴露与保护可能有效预防甲状腺手术后的嗓音损伤。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f0d/9840997/054c34cce1e4/gs-11-12-1976-f1.jpg

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