Department of Thyroid Surgery, First People's Hospital of Zunyi/Third Affiliated Hospital of Zunyi Medical University, Zunyi.
Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China.
Surg Laparosc Endosc Percutan Tech. 2023 Dec 1;33(6):587-591. doi: 10.1097/SLE.0000000000001238.
The aim of this study was to evaluate the influence of transoral endoscopic thyroidectomy vestibular approach (TOETVA) on voice changes and swallowing function disorders.
We retrospectively reviewed 215 patients who underwent thyroid surgery with TOETVA (105 cases, endoscopic group) and open approach (110 cases, open group). Major outcomes, the changes in voice and swallowing function in the 2 groups of patients before and after surgery were analyzed by using both subjective and objective evaluation indexes. Subjective evaluation indexes included the Voice Handicap Index, voice GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) classification, and swallowing impairment score; the objective indicators included the fundamental frequency (F0), fundamental frequency perturbation (jitter), amplitude perturbation (shimmer), and maximum phonation time.
In terms of subjective evaluation indexes, there were no significant differences (all P> 0.05) between the groups regarding Voice Handicap Index (1 and 3 mo after surgery) and GRBAS (1 and 3 mo after surgery). The incidence rates of swallowing disorder in the endoscopic group were higher than that in the open group according to the outcomes of swallowing impairment score at 1 and 3 months after surgery (both P< 0.05). In addition, no significant changes in terms of jitter, shimmer, and maximum phonation time in both groups of patients at 1 and 3 months after surgery compared with their preoperative values (all P> 0.05).
Voice and swallowing disorders may occur in some patients, either TOETVA or open thyroid surgery, which in most cases will recover within 3 months after surgery. The time to swallowing function recovery is relatively prolonged in patients following TOETVA, which may be probably associated with neck adhesion and fixation after the operation.
本研究旨在评估经口内镜甲状腺 Vestibular 入路（TOETVA）对声音变化和吞咽功能障碍的影响。
我们回顾性分析了 215 例行甲状腺手术的患者，其中 105 例采用 TOETVA（内镜组），110 例采用开放式手术（开放组）。通过使用主观和客观评估指标，分析两组患者手术前后的声音和吞咽功能变化。主观评估指标包括嗓音障碍指数、嗓音 GRBAS（等级、粗糙度、呼吸声、乏力、紧张度）分级和吞咽障碍评分；客观指标包括基频（F0）、基频微扰（抖动）、振幅微扰（声颤）和最长发声时间。
在主观评估指标方面，两组患者的嗓音障碍指数（术后 1 和 3 个月）和 GRBAS（术后 1 和 3 个月）均无显著差异（均 P>0.05）。根据术后 1 和 3 个月吞咽障碍评分的结果，内镜组吞咽障碍的发生率高于开放组（均 P<0.05）。此外，两组患者术后 1 和 3 个月的抖动、声颤和最长发声时间与术前相比均无显著变化（均 P>0.05）。
经口内镜甲状腺 Vestibular 入路或开放式甲状腺手术均可导致部分患者出现声音和吞咽障碍，大多数情况下，术后 3 个月内可恢复。经口内镜甲状腺 Vestibular 入路患者吞咽功能恢复时间相对较长，这可能与术后颈部粘连和固定有关。
