甲状腺切除术与甲状腺切除术加预防性中央区颈淋巴结清扫术后吞咽效率和安全性结果的二次分析。
Secondary analyses of swallowing efficiency and safety outcomes following thyroidectomy versus thyroidectomy plus prophylactic central neck dissection.
作者信息
Knigge Molly A, Robbins Daniel, Thibeault Susan, Connor Nadine, Sippel Rebecca
机构信息
University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA.
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA.
出版信息
Thyroid Res. 2025 Sep 16;18(1):45. doi: 10.1186/s13044-025-00264-5.
BACKGROUND
Swallowing complaints are common following total thyroidectomy, though an exact mechanism of patient-reported swallowing symptoms following thyroidectomy is currently lacking. This secondary, blinded analysis of data collected in a randomized, controlled clinical trial hypothesized that patients randomly assigned to the central neck dissection group would exhibit increased aspiration and pharyngeal residue on videofluoroscopic swallowing evaluation, and reduced patient-rated swallowing outcomes, as compared to patients randomized to thyroidectomy alone. We further hypothesized that blinded analysis would reveal worse swallowing function two-weeks post-surgery when compared to their pre-operative status to explain qualitative patient-reported dysphagia symptoms.
METHODS
Thirty-two participants randomized to total thyroidectomy treatment with or without central neck dissection underwent pre- and post-surgical evaluation of swallowing outcomes, including videofluoroscopic Penetration/Aspiration Scale ratings, Normalized Residue Ratio Scale measures of valleculae and pyriform sinus residue, and EAT-10 patient-rated outcomes.
RESULTS
No statistically significant differences were found post-surgery between randomized treatment groups for patient-rated EAT-10 scores (p = 0.2406), penetration/aspiration scale (p = 0.4465) or Normalized Residue Rating Scale scores for either vallecular or pyriform sinus sites. When group data were combined for analysis of differences between pre- and post-operative swallow performance, no statistically significant differences were found in patient-rated EAT-10 scores (p = 0.1374), penetration/aspiration scale (p = 0.7588) or Normalized Residue Rating Scale scores.
CONCLUSIONS
Measures of penetration/aspiration and pharyngeal residue failed to substantiate perceptions of post-operative dysphagia reported by patients undergoing total thyroidectomy with or without central neck dissection.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier NCT02138214.
背景
全甲状腺切除术后吞咽问题很常见，不过目前尚缺乏关于患者报告的甲状腺切除术后吞咽症状的确切机制。这项对一项随机对照临床试验中收集的数据进行的二次盲法分析假设，与仅接受甲状腺切除术的患者相比，随机分配到中央区颈淋巴结清扫组的患者在视频荧光吞咽评估中会出现更多误吸和咽部残留，且患者自评的吞咽结果会更差。我们进一步假设，盲法分析将显示，与术前状态相比，患者在术后两周的吞咽功能更差，以此来解释患者报告的定性吞咽困难症状。
方法
32名随机接受全甲状腺切除术加或不加中央区颈淋巴结清扫术治疗的参与者在手术前后接受了吞咽结果评估，包括视频荧光穿透/误吸量表评分、会厌谷和梨状窝残留的标准化残留率量表测量，以及EAT-10患者自评结果。
结果
随机治疗组术后在患者自评的EAT-10评分（p = 0.2406）、穿透/误吸量表（p = 0.4465）或会厌谷或梨状窝部位的标准化残留率量表评分方面未发现统计学上的显著差异。当合并组数据以分析术前和术后吞咽表现的差异时，在患者自评的EAT-10评分（p = 0.1374）、穿透/误吸量表（p = 0.7588）或标准化残留率量表评分方面未发现统计学上的显著差异。
结论
穿透/误吸和咽部残留的测量结果未能证实接受全甲状腺切除术加或不加中央区颈淋巴结清扫术的患者报告的术后吞咽困难感受。
试验注册
ClinicalTrials.gov标识符NCT02138214。
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