摘要
目的：探讨以突发声带麻痹为首发症状的甲状腺恶性肿瘤的临床特点，分析诊断、治疗过程中的注意点，避免漏诊、误诊。方法：对我科1999年2月-2003年2月收洽的5例以突发声带麻痹为首发症状的甲状腺恶性肿瘤患者的临床资料进行回顾性分析。结果：5例病理检查均证实为甲状腺乳头状腺癌，4例侵犯一侧喉返神经致声带麻痹，术中分离喉返神经后行患侧腺叶切除，其中3例术后6个月内恢复正常的声带外展及内收功能，1例对侧声带代偿，声音嘶哑好转；1例肿瘤先侵犯右侧喉返神经致声带麻痹，1年后肿瘤侵入喉内引起双侧环杓关节固定，声音嘶哑加重，出现呼吸困难，先行患侧腺叶切除加半喉切除，术后3个月复发，又行全喉切除，随访2年无复发。结论：对于突发声带麻痹，同侧甲状腺占位，排除其他部位病变者，建议手术探查甲状腺，术中暴露喉返神经并加以保护，术中快速冷冻切片，根据病理检查结果决定手术范围。
Objective： To approach clinical feature of thyroid malignant tumor with Flare up glottic paralysis for first symptom, and analysis that should be avoided missed diagnosis and misdiagnosis during diagnosis and treatment. Method： Retrospective research five cases of thyroid malignant tumor with flare up glottic paralysis papillary adenocarcinoma of thyroid by pathology. Four cases had one side glottic paralysis, the same side thyroid were moved after dissecting the recurrent laryngeal nerve. Three cases of them recovered normal vocal cord function, the function of one case was compensated by another side vocal cord. The last one had right gllotic paralysis first, then both cricoarytenoid joint had been fixed, hoarse voice was worse and developed to dyspnea since the tumor invaded in larynx one year later. We only did cut the right thyroid and right half larynx, but the tumor came back again in larynx in three months, then had to removal whole larynx without recurrence follow up two years. Conclusion：For the flare up glottic paralysis with same side tiny thyroid tumor, we suggest that the thyroid must be made operation research if no other reasons, dissecting and protecting the recurrent laryngeal nerve during operation, and cut reasonable thyroid and others according to fast pathologic diagnosis.
出处
《临床耳鼻咽喉科杂志》
CSCD
北大核心
2006年第13期608-610,共3页
Journal of Clinical Otorhinolaryngology
关键词
声带麻痹
甲状腺肿瘤
癌
乳头状
Vocal cord paralysis
Thyroid neoplasms
Carcinoma, papillary
