聲帶功能正常之全甲狀腺切除術後短期及長期音聲分析研究

Postoperative Objective Voice Analysis in Patients with Total Thyroidectomies and Intact Vocal Cord Function

李冠慧(Kuan-Hui Li) ； 余詠禧(Wing-Hei Viola, Yu) ； 江豐裕(Feng-Yu Chiang) ； 吳哲維(Che-Wei Wu) ； 林逸筑(Yi-Chu Lin) ； 陳淑貞(Shu-Chen Chen) ； 王秀文(Show-Wen Wang) ； 黃子晏(Tzu-Yen Huang)

《台灣耳鼻喉頭頸外科雜誌》 55卷3期 (2020/09) Pp. 135-142

https://doi.org/10.6286/jtohns.202009_55(3).135

摘要

背景：在全甲狀腺切除手術中使用神經監測有助於喉返神經及上喉神經外支之辨識及保留。即使聲帶功能正常且術中神經保留完整，病患術後亦可能產生音聲變化。本研究使用多向度嗓音分析及音域分析等客觀音聲分析工具，比較全甲狀腺切除術後之短期及長期音聲變化。方法：回溯性分析50名病人，藉由術中神經監測輔助之全甲狀腺切除術後其聲帶功能評估。病人於手術前、手術後3個月內及手術後1年以上，由單一語言治療師進行客觀音聲分析。並比較性別、年齡及病理之良惡性於音聲變化影響。結果：44名女性和6名男性，平均年齡52.8±13.1歲，病理診斷35名良性和15名惡性。與術前比較發現，術後短期之最高音下降、音高範圍減少及最長發聲時間變短有顯著變化；術後長期以基礎頻率下降、最低音上升顯著變化（p＜0.05）。女性術後短期噪音和諧和音比（noise to harmonic ratio）較男性差（p=0.002）；年齡對術後音聲變化無顯著差異；惡性腫瘤病人之術後長期最長發聲時間顯著較良性差（p=0.020）。結論：短期之客觀音聲不代表長期之音聲變化，長期音聲客觀數據與術前於基礎頻率及最低音有顯著差異，與病患主觀音聲之對應需後續研究。年齡對音聲的影響未達顯著，性別及病理良惡性在術後可能有不同的客觀音聲變化。

關鍵字

intraoperative neuromonitoring ； recurrent laryngeal nerve ； thyroid surgery ； voice analysis（術中神經監測 ； 喉返神經 ； 甲狀腺手術 ； 音聲分析）

並列摘要

BACKGROUND: Using intraoperative neuromonitoring (IONM) during thyroid surgery helps identify and preserve the recurrent laryngeal nerve and external branch of the superior laryngeal nerve. However, in recent studies, voice changes have still been noted after thyroidectomies in patients whose postoperative vocal cord function is intact. In this study, the multi-dimensional voice program and voice range profile were used to evaluate objective voice parameters, and further demonstrate short-term and long-term voice characteristics after total thyroidectomies. METHODS: We retrospectively analyzed 50 patients who received IONM-assisted total thyroidectomies with intact vocal cord function. The objective voice analyses were performed before, within 3 months (short-term) and more than one year (long-term) after the operation by a single speech-language pathologist. The impact of gender, age, and pathological results on voice parameters were compared between short-term and long-term groups. RESULTS: A total of44 women and 6 men were enrolled. Their average age was 52.8 ± 13.1 years and the pathological reports showed 35 patients with benign disease and 15 with malignant disease. The short-term maximum frequency, pitch range, and maximal phonation time (MPT), and long-term mean fundamental frequency and minimum frequency showed significant differences ( p ＜ 0.05) compared with the preoperative data. The short-term postoperative noise to harmonic ratio was significantly worse in women than men ( p = 0.002). Age was not a significant factor for voice change postoperatively. The long-term postoperative MPT was significantly worse in patients with malignant disease than those with benign disease ( p = 0.020). CONCLUSIONS: The results of short-term postoperative objective voice analysis may not predict long-term results, and the correspondence between subjective and objective voice analyses needs further research. Age is not a significant factor for voice change after total thyroidectomies. Gender and pathological results may influence postoperative voice parameters after total thyroidectomies.

並列關鍵字

intraoperative neuromonitoring ； recurrent laryngeal nerve ； thyroid surgery ； voice analysis