无喉返神经损伤的甲状腺切除术后早期嗓音声学变化

文献信息

中文摘要

目的： 甲状腺癌的发病率逐年上升，手术仍是主要治疗方式。临床上，即使术中未损伤喉神经，接受甲状腺切除术的患者也可能出现术后嗓音障碍。本回顾性研究旨在使用Praat软件客观评估已确认喉返神经（RLN）和喉上神经（SLN）功能保留的患者在甲状腺切除术后的嗓音声学变化。研究聚焦于术后72小时内的声学参数变化，并探讨相关影响因素，为术后嗓音损害的早期准确评估、识别和干预提供参考，以促进患者康复。
方法： 回顾性纳入2025年10月至2026年1月期间在我院接受全甲状腺切除术或甲状腺癌根治术的68例甲状腺乳头状癌患者。使用Praat软件在三个时间点进行声学分析：T0（术前1-3天）、T1（术后18-24小时）和T2（术后66-72小时）。在安静房间内录制元音/a/的持续发声，麦克风距受试者口部10 cm，使用数字录音机和麦克风系统。提取声学参数，包括基频（F0）、基频微扰（jitter）、振幅微扰（shimmer）以及作为呼吸发声功能指标的最长发声时间（MPT）。通过结构化问卷和病历收集临床特征、手术相关变量和围手术期数据，以分析术后嗓音损害的现状及潜在影响因素。
结果： 结果表明，在评估的声学参数中，T2时的基频微扰（jitter）对手术创伤的敏感性最高。术中出血量超过20 mL被确定为术后jitter变化的独立影响因素（β = 0.600，P < 0.001）。基频（F0）主要受性别影响（β = 0.390，P = 0.001）。然而，shimmer和MPT在术后超急性期未显示出显著预测价值。
结论： 甲状腺乳头状癌患者在接受甲状腺切除术后，即使术中无神经损伤，出现的嗓音异常也是可逆的。术后嗓音改变的严重程度与性别、术中淋巴结清扫范围及术中出血量相关。本研究支持一种基于特定声学指标与适当术后时间窗相匹配的评估策略，用于检测甲状腺切除术相关嗓音损害。在术后超急性期早期识别嗓音变化并对高危患者实施针对性干预，可能减轻嗓音功能障碍的严重程度并改善发声恢复。

英文摘要

OBJECTIVES: The incidence of thyroid cancer has been increasing annually, and surgery remains the primary therapeutic approach. Clinically, postoperative voice disorders may occur in patients undergoing thyroidectomy, even in the absence of intraoperative injury to the laryngeal nerves. This retrospective study aimed to objectively evaluate postoperative acoustic voice alterations after thyroidectomy using Praat software in patients with confirmed preservation of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) function. The study focused on changes in acoustic parameters within 72 hours after surgery and explored associated influencing factors, providing a reference for early and accurate assessment, identification, and intervention of postoperative voice impairment to facilitate patient recovery.
METHODS: A total of 68 patients diagnosed with papillary thyroid carcinoma who underwent total thyroidectomy or thyroid cancer radical surgery at our hospital between October 2025 and January 2026 were retrospectively enrolled. Acoustic analyses were performed using Praat software at three time points: T0 (1-3 days before surgery), T1 (18-24 hours after surgery), and T2 (66-72 hours after surgery). Sustained phonation of the vowel /a/ was recorded in a quiet room with the microphone positioned 10 cm from the participant's mouth using a digital recorder and microphone system. Acoustic parameters, including fundamental frequency (F0), jitter, shimmer, and the maximum phonation time (MPT), as an indicator of respiratory phonatory function, were extracted. Clinical characteristics, surgical-related variables, and perioperative data were collected through structured questionnaires and medical records to analyze the current status of postoperative voice impairment and potential influencing factors.
RESULTS: The results demonstrated that jitter at T2 exhibited the highest sensitivity to surgical trauma among the evaluated acoustic parameters. Intraoperative blood loss exceeding 20 mL was identified as an independent influencing factor for postoperative jitter variation (β = 0.600, P < 0.001). Fundamental frequency (F0) was primarily affected by sex (β = 0.390, P = 0.001). However, shimmer and MPT showed no significant predictive value during the hyperacute postoperative period.
CONCLUSIONS: Voice abnormalities occurring after thyroidectomy in papillary thyroid carcinoma patients without intraoperative nerve injury are reversible. The severity of postoperative voice alterations is associated with sex, the extent of intraoperative lymph node dissection, and intraoperative blood loss. This study supports an evaluation strategy based on the matching of specific acoustic indicators with appropriate postoperative time windows for detecting thyroidectomy-related voice impairment. Early identification of voice changes during the hyperacute postoperative phase and implementation of targeted interventions for high-risk patients may reduce the severity of voice dysfunction and improve phonatory recovery.