内镜或机器人甲状腺半切除术后嗓音随时间的术后变化

文献信息

中文摘要

目的： 术后嗓音障碍是甲状腺切除术后常见的关注问题。然而，在机器人和内镜入路中，术后嗓音恢复及其与临床病理因素的关系仍不清楚。本研究评估了两种手术入路中感知、声学、空气动力学和患者报告的嗓音结局随时间的术后变化，并根据临床病理因素识别恢复模式。
方法： 我们回顾性审查了2018年至2025年间因甲状腺恶性肿瘤接受微创甲状腺切除术的1106例患者。其中，纳入704例接受远程入路甲状腺切除术的患者，包括334例接受内镜甲状腺半切除术和370例接受机器人甲状腺半切除术。嗓音结局通过感知、声学多维嗓音程序（MDVP）和音高相关参数、空气动力学参数以及甲状腺切除相关嗓音和症状问卷进行评估。评估在术前和预定义的术后时间间隔（<1个月、1-3个月和≥3个月）进行。根据临床病理因素，包括体重指数（BMI）、中央颈清扫（CND）状态和肿瘤大小，分析这些时间点上嗓音结局的纵向变化。
结果： 两组患者的感知嗓音参数在术后早期均恶化，但到3个月时恢复。然而，F-high参数到3个月时未完全恢复（分别为P = 0.002和P < 0.001），而其他MDVP和音高相关参数恢复到基线水平。两组患者的空气动力学参数也在3个月后恢复。在BMI <18.5和18.5-24.9的患者、未接受CND的患者以及肿瘤≤1 cm的患者中，观察到临床相关嗓音障碍随时间显著改善。
结论： 在机器人和内镜甲状腺切除术后，嗓音功能通常在术后早期恶化，但一般在3个月内恢复到接近基线水平。在BMI <25的患者、未接受CND的患者以及肿瘤≤1 cm的患者中，观察到临床相关嗓音障碍随时间显著改善。

英文摘要

OBJECTIVE: Postoperative voice impairment is a common concern after thyroidectomy. However, postoperative voice recovery and its association with clinicopathologic factors remain unclear in robotic and endoscopic approaches. This study evaluated postoperative changes over time in perceptual, acoustic, aerodynamic, and patient-reported voice outcomes and identified recovery patterns according to clinicopathologic factors in both surgical approaches.
METHODS: We retrospectively reviewed 1106 patients who underwent minimally invasive thyroidectomy for thyroid malignancy between 2018 and 2025. Among them, 704 patients who underwent remote-access thyroidectomy were included, of whom 334 underwent endoscopic hemithyroidectomy and 370 underwent robotic hemithyroidectomy. Voice outcomes were assessed using perceptual, acoustic Multi-Dimensional Voice Program (MDVP) and pitch-related parameters, aerodynamic parameters, and the Thyroidectomy-related Voice and Symptom Questionnaire. Evaluations were performed preoperatively and at predefined postoperative intervals (<1 month, 1-3 months, and ≥3 months). Longitudinal changes in voice outcomes were analyzed across these time points according to clinicopathologic factors, including Body Mass Index (BMI), Central Neck Dissection (CND) status, and tumor size.
RESULTS: Perceptual voice parameters worsened during the early postoperative period in both groups but recovered by 3 months. However, the F-high parameter did not fully recover by 3 months (P = 0.002 and P < 0.001, respectively), whereas other MDVP and pitch-related parameters returned to baseline levels. Aerodynamic parameters also recovered after 3 months in both groups. Significant improvement in clinically relevant voice impairment over time was observed in patients with BMI <18.5 and 18.5-24.9, those who did not undergo CND, and those with tumors ≤ 1 cm.
CONCLUSION: Voice function typically deteriorates in the early postoperative period following both robotic and endoscopic thyroidectomy but generally recovers to near-baseline levels within 3 months. Significant improvement in clinically relevant voice impairment over time was observed in patients with BMI <n 25, those who did not undergo CND, and those with tumors ≤ 1 cm.