Nguyen Van Cuong, Song Chang Myeon, Ji Yong Bae, Lee Dong Won, Jeong Jin Hyeok, Tae Kyung
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea.
Ann Surg Oncol. 2025 Apr 15. doi: 10.1245/s10434-025-17276-y.
This study evaluated voice and swallowing outcomes following thyroidectomy by using the gasless transaxillary (GTAA) and transoral (TOA) approaches compared with the conventional transcervical approach (CTA).
A comprehensive search of the PubMed, EMBASE, and Cochrane Library databases was conducted through September 2024. Network meta-analyses were performed on 14 comparative studies, encompassing 1723 patients.
Voice handicap index (VHI)-10 scores, highest frequency, and frequency range deteriorated after surgery in all three methods. However, the postoperative voice outcomes of the GTAA and TOA were superior to the conventional approach at all follow-up points up to 3 months after the operation. Specifically, the VHI-10 scores of the GTAA and TOA were significantly lower than those of the CTA at 3 months postoperation. Other acoustic parameters, such as jitter, shimmer, noise-to-harmonic ratio, and intensity range, did not differ among the three methods. The postoperative swallowing impairment score (SIS)-6 of the GTAA and TOA were lower than that of the CTA. Specifically, the SIS-6 of the GTAA was significantly lower than those of the TOA and CTA at 3 months postoperation.
The postoperative voice and swallowing outcomes, especially VHI-10, highest frequency, frequency range, and SIS-6, following remote-access thyroidectomy using the GTAA and TOA were superior to those observed with the conventional approach. Given the limited number of studies included, further research is needed to confirm these findings as new studies emerge, especially those with larger sample sizes, diverse populations, different approaches, and extended follow-up periods.
本研究通过将无气经腋窝（GTAA）和经口（TOA）入路与传统经颈入路（CTA）进行比较，评估甲状腺切除术后的声音和吞咽结果。
截至2024年9月，对PubMed、EMBASE和Cochrane图书馆数据库进行了全面检索。对14项比较研究进行网络荟萃分析，涉及1723例患者。
所有三种方法术后声音障碍指数（VHI）-10评分、最高频率和频率范围均恶化。然而，在术后长达3个月的所有随访点，GTAA和TOA的术后声音结果均优于传统入路。具体而言，GTAA和TOA的VHI-10评分在术后3个月时显著低于CTA。其他声学参数，如抖动、闪烁、噪声与谐波比和强度范围，在三种方法之间没有差异。GTAA和TOA的术后吞咽障碍评分（SIS）-6低于CTA。具体而言，GTAA的SIS-6在术后3个月时显著低于TOA和CTA。
使用GTAA和TOA进行远程入路甲状腺切除术后的声音和吞咽结果，尤其是VHI-10、最高频率、频率范围和SIS-6，优于传统入路。鉴于纳入的研究数量有限，随着新研究的出现，特别是那些样本量更大、人群多样、方法不同和随访期延长的研究，需要进一步研究来证实这些发现。
