甲状腺结节术后患者语音评估及嗓音声学分析

目的 探讨分析甲状腺结节患者手术前后嗓音变化特点。 方法 选取行甲状腺手术的64例患者为研究对象,并依据手术方式和性别将其分为4组,分别为女性甲状腺全切术组(组1,18例)、女性甲状腺非全切术组(组2,28例)、男性甲状腺全切术组(组3,6例)、男性甲状腺非全切术组(组4,12例)。对患者术前、术后 3 d及术后 1个月分别进行电子鼻咽喉镜检查、动态喉镜检查、嗓音自我评估(VHI-10量表)、听感知评估(GRBAS评分)及嗓音声学分析检测,并对结果进行对比分析。 结果 所有患者术中均探查暴露喉返神经,喉返神经监测均有信号,声带活动均良好。在VHI-10量表和GRBAS评分方面,术后3 d时,组1患者在无力感(A)方面评分与组2患者在生理维度(P)及总嘶哑度(G)、粗糙度(R)评分方面较术前提高(t=-3.000,P=0.008;t=-2.200,P=0.037;t=-2.423,P=0.022;t=-2.423,P=0.022),均于术后1个月时恢复(P>0.05)。组3和组4的VHI-10及GRBAS评分各指标均与术前差异无统计学意义(P>0.05)。嗓音声学分析结果显示,术后3 d时,振幅微扰(shimmer)增大(组4 t=2.564,P=0.026)、最长发音时间(MPT)缩短(组1 t=2.419,P=0.027;组4 t=2.641,P=0.023)、最大声压级(SPLmax)减小(组1 t=4.930,P<0.001;组2 t=3.918,P=0.001;组3 t=4.399,P=0.007;组4 t=2.419,P=0.027)、发音障碍指数(DSI)有不同程度的减小(组1 t=4.570,P<0.001;组2 t=3.086,P=0.005;组3 t=3.166,P=0.025)。术后1个月时,4组数据中F0、jitter、shimmer、MPT、SPLmax、DSI均恢复到术前水平或远超术前水平,F0提高(组4)、jitter缩小(组1、组4)、shimmer缩小(组4)、MPT延长(组1)、DSI增大(组1、组2)(P<0.05)。 结论 甲状腺手术患者术后嗓音异常可能与性别、患者心理因素、肿瘤范围、喉返神经暴露情况等有关,无喉返神经麻痹的患者术后嗓音异常是可逆的。

Phonological assessment and analysis of voice patterns after thyroidectomy

Objective To investigate and analyze the voice changes in patients with thyroid nodules before and after surgery. Methods A total of 64 patients who underwent thyroidectomy between July 14, 2020, and September 1, 2020, were grouped according to the type of surgery and sex as follows: female patients with total thyroidectomy(group 1,18 cases), female patients with partial thyroidectomy(group 2, 28 cases), male patients with thyroidectomy(Group 3, 6 cases), and male patients with partial thyroidectomy(Group 4, 12 cases). Electronic nasopharyngolaryngoscopy, dynamic laryngoscopy, VHI-10, GRBAS, and voice acoustic analysis were performed preoperatively and on the third day and after 1 month postoperatively. Results The recurrent laryngeal nerve(RLN)was exposed during the surgery. All cases had RLN signals. Regarding VHI-10 and GRBAS, there was no significant difference between the preoperative and postoperative values of groups 3 and 4(P>0.05). The score of Asthenia(A)for group 1 and the scores of Physiology(P), total Hoarseness(G), and Roughness(R)for group 2 preoperatively and on the third day postoperatively were statistically significant(P<0.05). However, there was no statistically significant difference 1 month postoperatively(P>0.05). On the third postoperative day, the shimmer(group 4)increased(P<0.05)and the MPT(group 1, group 4), SPLmax(group 1, group 2, group3, group 4), and DSI(groups 1, 2, and 3)decreased(P<0.05). All the voice indicators returned to or became better than the preoperative levels 1 month postoperatively: the F0(group 4), MPT(group 1), and DSI(group1, group 2)increased(P<0.05), and the jitter(group1, group 4)and shimmer(group 4)decreased(P<0.05). Conclusion The abnormal voice of patients after thyroidectomy may be related to gender, psychological factors, tumor range, and recurrent laryngeal nerve exposure. The abnormal voice in patients without recurrent laryngeal nerve paralysis is reversible.