Page 70 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第43卷第12期
·1686 · Journal of Nanjing Medical University（Natural Sciences） 2023年12月

·临床研究·

术中神经监测对分化型甲状腺癌术后语音预后的影响

陈 月 ，张赟建 ，李 彬 ，林 勃 ，王子其 ，徐向东 1*
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中山大学附属第一医院甲状腺外科，乳腺外科，临床研究中心，广东 广州 510000
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［摘 要］ 目的：探讨术中神经监测（intraoperative neuromonitoring，IONM）对分化型甲状腺癌（differentiated thyroid carcinoma，
DTC）患者主观语音结局的影响。方法：回顾性分析从2018年9月—2019年3月在中山大学第一附属医院接受甲状腺手术的
DTC患者，分为IONM组和非IONM组，采用倾向评分匹配法（propensity score matching，PSM），比较两组患者的临床基线特征和
术后主观语音结果。结果：在预防性中央区淋巴结清扫亚组中，两组患者术后1个月、6个月的声音障碍指数⁃10（voice handi⁃
cap index⁃10，VHI⁃10）总分及甲状腺癌特异性生活质量（thyroid cancer specific quality of life，THYCA⁃QoL）问卷的声音领域均无
统计学差异（P > 0.05）。在靠近或侵犯后包膜亚组中，IONM组术后1个月、6个月的THYCA⁃QoL问卷中的声音领域评分中位
数（四分位数）均为0.00（0.00，0.00），低于非IONM组的0.00（0.00，33.33），差异有统计学意义（P=0.034）。均值均为5.73，明显
低于非IONM组的15.66（P=0.029）。VHI⁃10问卷两组差异无统计学意义。结论：IONM对DTC患者及预防性中央区淋巴结清
扫术亚组患者的主观发声障碍没有显著影响，但可明显改善靠近后包膜高危组患者术后主观声音异常。
［关键词］ 术中神经监测；分化型甲状腺癌；术后主观声音评估；声音障碍指数量表；甲状腺癌特异性生活质量问卷
［中图分类号］ R736.1 ［文献标志码］ A ［文章编号］ 1007⁃4368（2023）12⁃1686⁃08
doi：10.7655/NYDXBNS20231211

The influence of Intraoperative neuromonitoring on postoperative voice outcomes of

differentiated thyroid cancer
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CHEN Yue ，ZHANG Yunjian ，LI Bin ，LIN Bo ，WANG Ziqi ，XU Xiangdong 1*
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1 Department of Thyroid Surgery，Department of Breast Surgery，Department of Clinical Research Center，the First
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Affiliated Hospital of Sun Yat⁃sen University，Guangzhou 510000，China
［Abstract］ Objective：This study aims to investigate the effects of intraoperative neuromonitoring（IONM）on postoperative voice
outcomes of by differentiated thyroid cancer（DTC）. Methods：We assessed patients with DTC underwent thyroid surgery in the First
Affiliated Hospital of Sun Yat⁃sen University from September 2018 to March 2019. According to whether IONM was used or not，the
patients were divided into IONM group and non⁃IONM group. Clinicopathological characteristics and voice outcomes between IONM
and non⁃IONM patients with DTC were compared using propensity score matching（PSM）. Results：In the whole population and the
subgroup of lymph node dissection in the prevention center，there was no statistical difference between the two groups in the total score
of the voice handicap index ⁃ 10（VHI⁃10）and the voice field of the thyroid cancer specific quality of life（THYCA⁃QoL）questionnaire
1 and 6 months after surgery（P>0.05）. In the subgroup of approaching or invading the posterior capsule，the median（quartile）THYCA⁃
QoL voice score in the IONM group at 1 month and 6 months after surgery was 0.00（0.00，0.00）lower than in the non⁃IONM group 0.00
（0.00，33.33），（P=0.034）. The score of THYCA⁃QoL in the IONM group was 5.73 lower than that in the non⁃IONM group 15.66（P=
0.029）. There was no statistical difference in the VHI⁃ 10 questionnaire. Conclusion：IONM has no significant effect on subjective
phonation disorder in patients with DTC and subgroup patients with preventive central lymphadenectomy. However，it can significantly
improve the subjective voice abnormalities of patients in the approaching or invading the posterior capsule subgroup after surgery.
［Key words］ intraoperative neuromonitoring；differentiated thyroid cancer；postoperative subjective sound assessment；voice handi⁃
cap index⁃10；thyroid cancer specific quality of life questionnaire
［J Nanjing Med Univ，2023，43（12）：1686⁃1693］

［基金项目］ 广州市科技计划项目（201904010438）
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通信作者（Corresponding author），E⁃mail：xuxdong2@mail.sysu.edu.cn