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題名 | 神經監測無損傷之甲狀腺手術病患術後嗓音變化之初步研究=Voice Changes of Operative Thyroid Patients with Intact Recurrent Laryngeal Nerve Evidenced by Intra-Operative Nerve-Monitoring |
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作者 | 方紹宇; 王南梅; 辛宗翰; 蘇茂昌; 陳宣志; 曹傑漢; Fang, Sau-wu; Wang, Nan-mai; Hsin, Chung-han; Su, Mao-chang; Chen, Shiuan-chih; Tsao, Chien-han; |
期刊 | 臺灣耳鼻喉頭頸外科雜誌 |
出版日期 | 20120100、20120200、20120300 |
卷期 | 47:1 2012.01-03[民101.01-03] |
頁次 | 頁14-23 |
分類號 | 416.896 |
語文 | chi |
關鍵詞 | 術中神經監測系統; 多向度嗓音分析程式; 即時音高程式; 嗓音障礙指數量-10; 音高; Intraoperative neuromonitoring system; Multi-dimensional voice program; Real time pitch program; Voice Handicap Index-10; Pitch; |
中文摘要 | 背景:甲狀腺手術的要求,不單以治療疾病,手術後的音聲品質保存亦是病患重要的訴求。使用神經監測系統能夠協助醫師探測喉返及喉上神經。然而即使神經完整,術後是否仍有音聲品質改變是值得採究的議題。方法:蒐集2010年3月至2010年6月甲狀腺手術中神經監測(intraoperative neuromonitoring system, IONM)無受損證據之患者共14名。術前經過音聲與歌唱訓練後,於標準隔音室內使用多向度嗓音分析軟體(multi-dimensional voice program, MDVP)蒐集患者的術前音聲參數,另以即時音高(real time pitch)軟體獲得患者的最低與最高音高(pitch)資料,並完成嗓音障礙指數量表(Voice Handicap Index-l0, VHI-10)。於手術後l個月再次收集相關參數。以VHI-l0為病患主觀知覺的評估依據,探討影響量表分數的相關因子。手術前後音聲參數的變化使用Wilcoxon signed rank檢定。採Spearman's相關分析來檢測手術前後音聲參數與音高變化量與VHI-10改變量的相關性。採雙尾檢定,p<0.05為達統計上顯著意義。結果:手術前與術後l個月的客觀音質參數差距諸如;基頻(fundamental frequency)、基頻變動率(Fo-Var)、頻率擾動率(jitter, %)、音準週期擾動商數(pitch period perturbation quotient, PPQ)、震幅擾動比率(Shimmer, %)、振幅擾動商數(amplitude perturbation quotient, APQ)、噪音諧音比(noise-to-harmonic ratio, NHR)、音聲紊亂指標(voice turbulence index, VTI)、輕聲指標分數(soft phonation index, SPI)均未達到統計上顯著差異;而在最高音高(highest pitch)(p=0.003),音高範園(pitch range)(p=0.02),最高音節(highest note)(p=0.0019)方面均呈現較術前有意義的降低。主觀的音聲變化方面,手術後l個月的嗓音障礙指數呈現較術前微幅上升,但未達到統計上顯著差異。而基頻(r=-0.536,P=0.048)、最大發聲時間(r=-0.677,p=0.008)、最高音高(r=-0.480,p=0.006)、最高音節(r=-0.656,P=0.006)與音節範圍(r=-0.522,p=0.038)的前後差距與嗓音障礙指數變化有統計上的相關。結論:神經監測系統確定喉返與喉上神經完整者,術後l個月的最高音高,音高範圍,最高音節較術前呈現有意義的減少。此外,術後音高,最大發生時間與基頻的變化會與嗓音障礙指數量表-10的分數增加有關。 |
英文摘要 | BACKGROUND: Among patients undergoing thyroid surgery, individuals expect not only good results in terms of disease treatment but also the post-operative preservation of voice quality is also vital. With the help of a nerve-monitoring system, surgeons are now better able to detect the presence of the recurrent laryngeal nerve and the superior laryngeal nerve during the operation. Nevertheless, even if the nerves retain integrity and remain intact intra-operatively, changes in voice quality post-operatively still occur and need to be investigated.METHODS: Fourteen patients who underwent thyroid surgery between March 2010 and June 2010 and had been shown to be without nerve injury using the Intraoperative Neuromonitoring System (IONM) were enrolled in the study. Their voices were evaluated using a multidimensional voice analysis software (multi-dimensional voice program, MDVP). The patients were initially recorded in a soundproof booth before surgery. The patients had to undertake adequate voice and singing training before this first evaluation. In addition, the patient's lowest and highest pitch was collected using real time pitch software. A Voice Handicap Index-10 (VHI-10) was calculated from the collected data obtained before surgery and at one month after surgery. Relevant factors related to the patients' satisfaction with their post-operative voice quality were analyzed based on the results of VHI-10. The change in voice data pre-operation versus postoperation was tested by the Wilcoxon signed rank test. Changes in voice data, pitch, and VHI-10 were assessed using Spearman's correlation. A two-tailed p < 0.05 was regard as statistically significant.RESULTS: Various objective acoustic parameters, including fundamental frequency, Fo-Var, jitter%, pitch period perturbation quotient (PPQ), Shimmer%, amplitude perturbation quotient (APQ), noise-to-harmonic ratio (NHR), voice turbulence index (VTI), and soft phonation index (SPI), showed no significant changes between before surgery and one month after surgery. The highest pitch (p = 0.003), the pitch range (p = 0.002) and the highest note (p = 0.00019) did show significant decreases. The VHI-10 scale values showed a slight increase but the change was not significant. The parameters that were statistically associated with the changes in VHI-10 included average fundamental frequency change (r = -0.536, p = 0.048), maximum phonation time (r = -0.677, p = 0.008), highest frequency (r = -0.480, p = 0.006), highest note (r = -.656, p = 0.006) and note range (r = -0.522, p = 0.038)CONCLUSION: Significant decreases in highest pitch, pitch range and highest note confirmed using INOM were observed one month after thyroid surgery among patients with intact recurrent laryngeal and superior laryngeal nerves. Furthermore, differences in pitch, maximum phonation time, and fundamental frequency change were found to be associated with an increase in VHI-10 scale measurements. |
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