目的

探讨通过经皮喉部超声（TLUSG）实时观察声带运动及定量参数的测量，动态监测甲状腺微波消融术患者喉返神经功能的应用价值。

方法

回顾性分析2022年1月至2024年5月在中国科学技术大学附属第一医院接受甲状腺单侧叶结节微波消融手术治疗的患者共63例。所有患者在TLUSG动态观察深吸气和发“e”音时声带运动情况，留存2种状态时的动态图像。在最佳切面冻结图像时测量并记录单侧声带角度及单侧声带最大移动度。应用重复测量资料方差分析对比术前，术后即刻，术后1、3、6个月患侧和健侧声带的超声检查结果差异，采用Bonferroni法进行两两比较。

结果

患侧声带角度受时间的主效应影响显著（F_时间=14.885，P＜0.001），声带最大移动度受时间的主效应影响显著（F_时间=10.599，P=0.001），声带最大移动度和声带角度受分组主效应和分组与时间的交互效应不显著（P＞0.05）。事后多重比较发现，患侧声带最大移动度和声带角度术后即刻与术前相比均显著下降［（7.652±0.226）mm vs （7.887±0.364）mm；（24.984±0.258）° vs （26.222±0.303）°］，差异具有统计学意义（t=-4.212、-5.982，P均＜0.001），术后1、3、6个月与术前相比，差异均无统计学意义（P均＞0.05）；健侧声带最大移动度和声带角度术后各时间节点与术前相比，差异均无统计学意义（P均＞0.05）。

结论

TLUSG可无创、实时、定量地对甲状腺微波消融患者声带运动行术中及术后评估，对喉返神经功能的动态监测具有重要辅助作用。

Objective

To assess the dynamic functional changes of the recurrent laryngeal nerve （RLN） following thyroid microwave ablation （MWA） through quantitative transcutaneous laryngeal ultrasonography （TLUSG） by integrating real-time vocal fold kinematic visualization and parametric analysis.

Methods

This retrospective cohort study analyzed 63 consecutive patients who underwent unilateral thyroid nodule MWA at a tertiary academic center between January 2022 and May 2024. TLUSG was performed preoperatively， immediately post-ablation， and at 1/3/6-month follow-ups. Dynamic vocal fold motion was recorded during phonation （‘e’ sustained） and quiet breathing， with optimal frozen images analyzed for angular measurements （anterior commissure displacement） and maximum glottic width. A linear mixed-effects model with repeated measures ANOVA was used to evaluate temporal trends， group effects （ablated vs contralateral side）， and interaction terms， and the Bonferroni method was used for pairwise comparisons.

Results

Significant time main effects were observed for vocal fold angle （F_time=14.885，P＜0.001） and maximum displacement （F_time=10.599， P=0.001） on the treated side. Neither group main effects nor group-time interactions reached statistical significance （P＞0.05 for all）. Post hoc analysis demonstrated immediate postoperative reductions in treated-side maximum displacement and angle ［（7.652±0.226） mm vs （7.887±0.364） mm， t=-4.212， P＜0.001； （24.984±0.258）° vs （26.222±0.303）°， t=-5.982， P＜0.001），with values returning to baseline levels by postoperative month 1 （P＞0.05 at 1/3/6 months）. No significant temporal variations were detected in contralateral vocal fold parameters （P＞0.05 across all intervals）.

Conclusion

TLUSG can non-invasively， rapidly， economically， accurately， and quantitatively assess the vocal cord movement of patients undergoing thyroid microwave ablation in real time during surgery and in outpatient settings， reducing the need for invasive flexible laryngoscopy， and plays an important auxiliary role in the dynamic monitoring of recurrent laryngeal nerve function.