山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (3): 20-27.doi: 10.6040/j.issn.1673-3770.1.2020.110

• 临床研究 • 上一篇    下一篇

甲状腺结节术后患者语音评估及嗓音声学分析

梁程程,雷大鹏,王欣,侯波,李梅   

  1. 山东大学), 山东 济南 250012
  • 发布日期:2021-05-14
  • 通讯作者: 雷大鹏. E-mail:leidapeng@sdu.edu.cn
  • 基金资助:
    国家自然科学基金面上项目(82071918);山东省重点研发计划项目(2019GSF108003);山东省重点研发计划项目(2019GSF108097)

Phonological assessment and analysis of voice patterns after thyroidectomy

LIANG Chengcheng, LEI Dapeng, WANG Xin, HOU Bo, LI Mei   

  1. Department of Otorhinolaryngology, Qilu Hospital, Cheeloo College of Medicine, of Shandong University/NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan 250012, Shandong, China
  • Published:2021-05-14

摘要: 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。

关键词: 甲状腺手术, 语音评估, 嗓音声学分析, 手术方式, 性别

Abstract: 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.

Key words: Thyroidectomy, Phonological assdssment, Acoustice voice analysis, Operation mode, Gender

中图分类号: 

  • R767.92
[1] 潘新良. 加强甲状腺结节及恶性肿瘤的规范治疗[J]. 山东大学耳鼻喉眼学报, 2020,34(3): 1-12. doi:10.6040/j.issn.1673-3770.1. 2020.037. PAN Xinliang. Improving the standard treatments for thyroid nodules and malignant tumors[J]. J Otolaryngol Ophthalmol Shandong Univ, 2020, 34(3): 1-12. doi:10.6040/j.issn.1673-3770.1. 2020.037.
[2] 韩婧, 康骅. 甲状腺癌的发病现状及影响因素[J]. 实用预防医学, 2018, 25(7): 894-897. doi:10.3969/j.issn.1006-3110.2018.07.037. HAN Jing, KANG Hua. Prevalence and influencing factors of thyroid cancer[J]. Pract Prev Med, 2018, 25(7): 894-897. doi:10.3969/j.issn.1006-3110.2018.07.037.
[3] Henry LR, Helou LB, Solomon NP, et al. Functional voice outcomes after thyroidectomy: an assessment of the Dsyphonia Severity Index(DSI)after thyroidectomy[J]. Surgery, 2010, 147(6): 861-870. doi:10.1016/j.surg.2009.11.017.
[4] Kuhn MA, Bloom G, Myssiorek D. Patient perspectives on dysphonia after thyroidectomy for thyroid cancer[J]. J Voice, 2013, 27(1): 111-114. doi:10.1016/j.jvoice.2012.07.012.
[5] Lan XB, Zhang H. An introduction of surgical update in 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer[J]. Chin J Surg, 2016, 54(3): 172-176. doi:10.3760/cma.j.issn.0529-5815.2016.03.004.
[6] Nixon IJ, Wang LY, Migliacci JC, et al. An International Multi-Institutional Validation of Age 55 Years as a Cutoff for Risk Stratification in the AJCC/UICC Staging System for Well-Differentiated Thyroid Cancer[J]. Thyroid,2016, 26(3): 373-380. doi: 10.1089/thy.2015.0315.
[7] Tuttle RM, Haugen B, Perrier ND. Updated American joint committee on cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer(eighth edition): what changed and why?[J]. Thyroid, 2017, 27(6): 751-756. doi:10.1089/thy.2017.0102.
[8] 赵瑞敏, 黄健华, 朱云, 等. 甲状腺部分或全切除术后患者的嗓音主客观检测结果分析[J]. 听力学及言语疾病杂志, 2019,27(2): 189-192. doi:10.3969/j.issn.1006-7299.2019.02.019. ZHAO Ruimin, HUANG Jianhua, ZHU Yun, et al. Analysis of subjective and objective voice analysis after partial or total thyroidectomy[J]. J Audiol Speech Pathol, 2019, 27(2): 189-192. doi:10.3969/j.issn.1006-7299.2019.02.019.
[9] 徐文,李红艳,胡蓉,等. 嗓音障碍指数量表中文版信度和效度评价[J]. 中华耳鼻咽喉头颈外科杂志,2008,43(9):670-675. doi:10.3321/j.issn:1673-0860.2008.09.008. XU Wen, LI Honguan, HU Rong, et al. Analysis of reliability and validity of the Chinese version of voice handicap index(VHI)[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2008, 43(9): 670-675. doi:10.3321/j.issn:1673-0860.2008.09.008.
[10] Awan SN, Roy N, Cohen SM. Exploring the relationship between spectral and cepstral measures of voice and the Voice Handicap Index(VHI)[J]. J Voice, 2014, 28(4): 430-439. doi:10.1016/j.jvoice.2013.12.008.
[11] Barsties B, Kropp J, Dicks P, et al. Reliability and validity of the “voice handicap index(VHI)adapted to the singing voice”[J]. Laryngorhinootologie, 2015, 94(7): 441-446. doi:10.1055/s-0034-1387765.
[12] Kosztya-Hojna B, Zdrojkowski M, Duchnowska E. The application of High-Speed camera(HS), acoustic analysis and Voice Handicap Index(VHI)questionnaire in diagnosis of voice disorders in elderly men[J]. Otolaryngol Polska, 2019, 73(5): 25-30. doi:10.5604/01.3001.0013.3335.
[13] Khoramshahi H, Khatoonabadi AR, Khoddami SM, et al. Responsiveness of Persian version of consensus auditory perceptual evaluation of voice(CAPE-V), Persian version of voice handicap index(VHI), and praat in vocal mass lesions with muscle tension dysphonia[J]. J Voice, 2018, 32(6): 770. doi:10.1016/j.jvoice.2017.08.008.
[14] De Bodt MS, Wuyts FL, Van de Heyning PH, et al. Test-retest study of the GRBAS scale: influence of experience and professional background on perceptual rating of voice quality[J]. J Voice, 1997, 11(1): 74-80. doi: 10.1016/s0892-1997(97)80026-4.
[15] Tedla M, Chakrabarti S, Suchankova M, et al. Voice outcomes after thyroidectomy without superior and recurrent laryngeal nerve injury: VoiSS questionnaire and GRBAS tool assessment[J]. Eur Arch Otorhinolaryngol, 2016, 273(12): 4543-4547. doi:10.1007/s00405-016-4163-6.
[16] Moro-Velázquez L, Gómez-García JA, Godino-Llorente JI, et al. Modulation spectra morphological parameters: a new method to assess voice pathologies according to the GRBAS scale[J]. Biomed Res Int, 2015, 2015: 259239. doi:10.1155/2015/259239.
[17] 徐婷, 余蓉, 周琦, 等. 应用中文版嗓音活动及参与量表评估嗓音疾病患者生活质量的临床研究[J]. 临床耳鼻咽喉头颈外科杂志, 2019,33(10): 987-990. doi:10.13201/j.issn.1001-1781.2019.10.021. XU Ting, YU Rong, ZHOU Qi, et al. The clinical study of Chinese version of voice activities and participation profile in patients with voice disorder[J]. J Clin Otorhinolaryngol Head Neck Surg, 2019, 33(10): 987-990. doi:10.13201/j.issn.1001-1781.2019.10.021.
[18] 李晓雨, 李进让. 嗓音障碍指数主观评估与发音障碍严重程度指数客观检测的相关性分析[J]. 中国耳鼻咽喉头颈外科, 2016,23(2): 122-124. doi:10.16066/j.1672-7002.2016.02.016. LI Xiaoyu, LI Jinrang. Correlation between voice handicap index and voice acoustic analysis in patients with vocal cord polyps[J]. Chin Arch Otolaryngol-Head Neck Surg, 2016,23(2): 122-124. doi:10.16066/j.1672-7002.2016.02.016.
[19] Paulauskiene I, Lesinskas E, Petrulionis M. The temporary effect of short-term endotracheal intubation on vocal function[J]. Eur Arch Otorhinolaryngol, 2013, 270(1): 205-210. doi:10.1007/s00405-012-2130-4.
[20] Park YM, Oh KH, Cho JG, et al. Changes in voice- and swallowing-related symptoms after thyroidectomy: one-year follow-up study[J]. Ann Otol Rhinol Laryngol, 2018, 127(3): 171-177. doi:10.1177/0003489417751472.
[21] Kim CS, Park JO, Bae JS, et al. Long-lasting voice-related symptoms in patients without vocal cord palsy after thyroidectomy[J]. World J Surg, 2018, 42(7): 2109-2116. doi:10.1007/s00268-017-4438-0.
[22] van Houtte E, van Lierde K, Claeys S. Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge[J]. J Voice, 2011, 25(2): 202-207. doi:10.1016/j.jvoice.2009.10.009.
[23] Behlau M, Zambon F, Madazio G. Managing dysphonia in occupational voice users[J]. Curr Opin Otolaryngol Head Neck Surg, 2014, 22(3): 188-194. doi:10.1097/MOO.0000000000000047.
[24] Christakis I, Klang P, Talat N, et al. Long-term quality of voice is usually acceptable after initial hoarseness caused by a thyroidectomy or a parathyroidectomy[J]. Gland Surg, 2019, 8(3): 226-236. doi:10.21037/gs.2018.09.02.
[25] 於子卫, 庞正. 嗓音疾病患者手术前后的自我评估、声学分析、喉镜检查及其相关性研究[J]. 临床耳鼻咽喉头颈外科杂志, 2010,24(21): 980-982,986. doi:10.3969/j.issn.1001-1781.2010.21.007. YU Ziwei, PANG Zheng. Study on self-assessment, acoustic analysis, laryngoscopy for patients with voice surgery[J]. J Clin Otorhinolaryngol Head Neck Surg, 2010, 24(21): 980-982,986. doi:10.3969/j.issn.1001-1781.2010.21.007.
[26] 任佳, 杨慧, 吕丹, 等. 甲状腺全切手术患者术前与术后嗓音功能对比研究[J]. 临床耳鼻咽喉头颈外科杂志, 2019,33(8): 757-760. doi:10.13201/j.issn.1001-1781.2019.08.018. REN Jia, YANG Hui, LÜ Dan, et al. A cmparative study of the voice function change in patients who underwent total thyroidectomy between preoperative and postoperative[J]. J Clin Otorhinolaryngol Head Neck Surg, 2019, 33(8): 757-760. doi:10.13201/j.issn.1001-1781.2019.08.018.
[27] 王英俊, 华辉, 葛瑞锋, 等. 甲状腺切除术后患者嗓音声学分析动态观察[J]. 听力学及言语疾病杂志, 2016, 24(5): 469-472. doi:10.3969/j.issn.1006-7299.2016.05.012. WANG Yingjun, HUA Hui, GE Ruifeng, et al. Voice acoustic analysis in parients underwent thyroidectomy[J]. J Audiol Speech Pathol, 2016, 24(5): 469-472. doi:10.3969/j.issn.1006-7299.2016.05.012.
[28] 马艳利, 徐新林, 侯光辉, 等. 单侧声带麻痹和单侧环杓关节脱位患者的声学特性分析[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(4): 268-271. doi:10.13201/j.issn.1001-1781.2016.04.003. MA Yanli, XU Xinlin, HOU Guanghui, et al. Acoustic analysis in patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis[J]. J Clin Otorhinolaryngol Head Neck Surg, 2016, 30(4): 268-271. doi:10.13201/j.issn.1001-1781.2016.04.003.
[29] Moris D, Mantonakis E, Makris M, et al. Hoarseness after thyroidectomy: blame the endocrine surgeon alone?[J]. Hormones(Athens), 2014, 13(1): 5-15. doi:10.1007/BF03401316.
[30] de Pedro Netto I, Fae A, Vartanian JG, et al. Voice and vocal self-assessment after thyroidectomy[J]. Head Neck, 2006, 28(12): 1106-1114. doi:10.1002/hed.20480.
[31] Paulauskiene I, Lesinskas E, Petrulionis M. The temporary effect of short-term endotracheal intubation on vocal function[J]. Eur Arch Otorhinolaryngol, 2013, 270(1): 205-210. doi:10.1007/s00405-012-2130-4.
[32] Pereira JA, Girvent M, Sancho JJ, et al. Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy[J]. Surgery, 2003, 133(3): 318-322. doi:10.1067/msy.2003.58.
[33] Maeda T, Saito M, Otsuki N, et al. Voice quality after surgical treatment for thyroid cancer[J]. Thyroid, 2013, 23(7): 847-853. doi:10.1089/thy.2012.0060.
[34] Duclos A, Lifante JC, Ducarroz S, et al. Influence of intraoperative neuromonitoring on surgeons' technique during thyroidectomy[J]. World J Surg, 2011, 35(4): 773-778. doi:10.1007/s00268-011-0963-4.
[35] 韦伟, 韩彬, 李朋, 等. 术中喉返神经监测系统在甲状腺开放手术中的应用[J]. 中国耳鼻咽喉头颈外科,2010,1:23-25. doi:10.16066/j.1672-7002.2010.01.001.
[36] 朱新, 黄志纯, 冯旭, 等. Ligasure血管闭合系统、超声刀及电刀在甲状腺手术中应用的对比分析[J]. 中国耳鼻咽喉头颈外科, 2016,23(9): 544-545. doi:10.16066/j.1672-7002.2016.09.014.
[37] 刘斌, 周文辉, 徐静. 甲状腺手术环杓关节脱位导致声嘶二例诊治分析[J]. 临床外科杂志, 2018,26(3): 191-192. doi:10.3969/j.issn.1005-6483.2018.03.010.
[38] 吴林格尔,申乐,黄宇光. 气管插管后环杓关节脱位的危险因素与诊疗进展[J]. 中华麻醉学杂志,2019,6:644-646. doi:10.3760∕cma.j.issn.0254-1416.2019.06.002. WU Lingeer, SHEN Le, HUANG Yuguang. Risk factors for and clinical progress in arytenoid dislocation after endotracheal intubation[J]. Chin J Anesthesiol, 2019, 39(6): 644-646. doi:10.3760∕cma.j.issn.0254-1416.2019.06.002.
[39] 钟燕梅, 殷海, 何引, 等. 嗓音训练及评估方法在嗓音疾病患者中的应用价值[J]. 右江医学, 2017,45(3): 289-293. doi:10.3969/j.issn.1003-1383.2017.03.008. ZHONG Yanmei, YIN Hai, HE Yin, et al. Application value of voice training and assessment methods in patients with voice disease[J]. Chin Youjiang Med J, 2017, 45(3): 289-293. doi:10.3969/j.issn.1003-1383.2017.03.008.
[40] 康炜骠,郑亿庆,梁发雅,等.甲状腺术后单侧声带麻痹患者嗓音训练效果分析[J].听力学及言语疾病杂志,2017, 25(4):426-429. doi:10.3969/j.issn.1006-7299.2017.04.023.
[1] 侯波,梁程程,魏东敏,雍蓉,雷大鹏,李梅. 耳鼻咽喉门诊咽喉良性病变老年患者喉镜观察与嗓音声学分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 20-25.
[2] 王赫,宋西成. 加速康复外科在甲状腺围手术期的应用[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 101-107.
[3] 武振,房居高. 经口腔前庭腔镜甲状腺手术进展与争议[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 13-18.
[4] 钟琦. 甲状腺手术中甲状旁腺的识别和保护[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 9-11.
[5] 刘文君,于雪莹,吕丹,陈正岗,张艳青,梅栩彬,杨珂. 不同性别阻塞性睡眠呼吸暂停低通气综合征患者与上气道影像学相关性的研究[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 54-59.
[6] 朱亚骄, 薛飞, 王秋萍. 90例耳鸣患者心理声学特征研究[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 14-17.
[7] 庄大勇,贺青卿,范子义,景大海,周鹏. 腋-胸径路达芬奇机器人甲状腺腺叶切除1例[J]. 山东大学耳鼻喉眼学报, 2014, 28(2): 38-40.
[8] 王晓彬1,潘新良2,卢永田1,魏明辉1,孙焕吉1,苗北平1. 早期声门区癌的手术治疗及疗效评估[J]. 山东大学耳鼻喉眼学报, 2013, 27(4): 53-58.
[9] 王银燕,李路路,陶钰,申家泉. 535例门诊青光眼患者流行病学资料分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(3): 56-59.
[10] 于德先,皮士军,马庆,张文山. 气管、支气管异物患儿再手术46例临床分析[J]. 山东大学耳鼻喉眼学报, 2011, 25(6): 89-91.
[11] 朱海容
. 孔源性视网膜脱离节段性垫压术后再手术原因及术式选择[J]. 山东大学耳鼻喉眼学报, 2009, 23(1): 90-91 .
[12] 朱肇峰,王跃建,梁玉颜,陈伟雄,陈瑞开 . 早期声门型喉癌激光术后发音功能的客观声学分析[J]. 山东大学耳鼻喉眼学报, 2007, 21(4): 352-354 .
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 邓基波,孙奉乾,许安廷 . 大前庭导水管综合征[J]. 山东大学耳鼻喉眼学报, 2006, 20(2): 116 -118 .
[2] 周子宁,金国威 . 喉气管狭窄的预防和治疗进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(5): 462 -465 .
[3] 周斌,李滨 . 鼻内窥镜下鼻窦鼻息肉手术75例疗效观察[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 24 -26 .
[4] 徐赛男,杨雷 . 红霉素促进鼻息肉上皮细胞凋亡的实验研究[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 27 -29 .
[5] 张玉光,韩旭光,张华,王旭,徐湘辉 . 改良穿透性角膜移植术治疗真菌性角膜炎[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 94 -95 .
[6] 刘联合 . 颈深部脓肿37例[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 180 -181 .
[7] 谢治年 ,姬长友 . RNA干扰及其在喉鳞癌研究中的应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 200 -203 .
[8] 乔 艺,倪关森,陈文文 . 改良悬雍垂腭咽成形术联合鼻腔手术治疗阻塞性睡眠呼吸暂停综合征38例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 206 -208 .
[9] 汪晓锋,林 昶,程金妹 . 不同龄小鼠内耳中ABAD的表达及临床意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 207 -211 .
[10] 凡启军,黄治物,梅 玲,肖伯奎 . 荧光定量PCR测定水杨酸钠作用后大鼠耳蜗基因的表达[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 212 -214 .