良性结节性甲状腺肿手术后,患者可能会出现颈部和肩部疼痛,颈部压力和密封性,窒息的感觉,改变语音功能,和吞咽困难导致短期生活质量(QoL)下降。这项单盲随机对照试验研究了甲状腺切除术后康复颈部拉伸和运动锻炼对包括QoL在内的这些变量的影响。
接受甲状腺叶切除术或全甲状腺切除术的患者在术后四周内随机进行3次颈部拉伸和运动锻炼(干预组)或不进行运动的常规随访(对照组)。结果指标是以下问卷中的分数:疾病特异性甲状腺相关患者报告的结果(ThyPRO-39),涉及颈部饱腹感的症状,喉咙里的压力,“和”吞咽不适“结合在多项目甲状腺肿症状量表中,语音障碍-索引-10(VHI-10),通过数字评定量表(NRS)测量颈部和肩部疼痛,和一般健康测量(EQ-5D-5L)。手术前评估所有分数,两个,四周,手术后三个月.使用线性混合模型分析数据。
89例患者被随机分为对照组(45例)和干预组(44例)。手术后三个月,对照组和干预组均在ThyPRO问卷的甲状腺肿症状和甲状腺功能亢进症状量表方面经历了大至中度的改善(p<0.004).在任何其他应用的量表中均未发现明显的组间差异。
这项研究证实,良性结节性甲状腺肿手术后患者的QoL有显著改善。然而,甲状腺切除术后早期颈部拉伸和运动锻炼并未导致QoL进一步改善,主要接受甲状腺叶切除术的患者疼痛减轻或主观语音功能受影响较小。试用注册号NCT04645056(https://clinicaltrials.gov)。
Following surgery for benign nodular goiter, patients may experience neck and shoulder pain, neck pressure and tightness, choking sensation, altered voice function, and dysphagia leading to decreased short-term quality of life (QoL). This single-blinded randomized controlled
trial investigated the effect of post-thyroidectomy rehabilitative neck stretching and movement exercises on these variables including QoL.
Patients undergoing thyroid lobectomy or total thyroidectomy were randomized to perform neck stretching and movement exercises three times daily in four weeks following surgery (intervention group) or conventional follow-up without exercises (control group). Outcome measures were scores in the following questionnaires: Disease-specific Thyroid-Related Patient-Reported Outcome (ThyPRO-39) involving symptoms of \"sense of fullness in the neck,\" \"pressure in the throat,\" and \"discomfort swallowing\" combined in the multi-item Goiter Symptom Scale, the Voice Handicap-Index-10 (VHI-10), neck and shoulder pain measurement by a numeric rating scale (NRS), and General measure of health (EQ-5D-5L). All scores were assessed prior to surgery and one, two, four weeks, and three months after surgery. Data were analyzed using a linear mixed model.
Eighty-nine patients were included and randomized to the control (n = 45) or the intervention group (n = 44). At three months after surgery, both the control and the intervention group experienced large to moderate improvements in the Goiter symptom and Hyperthyroid symptom scale of the ThyPRO questionnaire (p < 0.004). No significant between-group differences were found in any of the other applied scales.
This
study confirms that patients experience profound improvements in QoL after surgery for benign nodular goiter. However, early post-thyroidectomy neck stretching and movement exercises did not result in further QoL improvement, reduction in pain or less impacted subjective voice function for patients primarily undergoing thyroid lobectomy.
Trial Registration Number NCT04645056 ( https://clinicaltrials.gov ).