住院病患聲帶麻痺病之病因探討：十年之分析報告

Etiology of Vocal Cord Paralysis in Hospitalized Patients: A 10-Year Analysis

丘逢翔(Feng-Shiang Chiu) ； 陳信傑(Hsin-Chien Chen) ； 王智弘(Chih-Hung Wang) ； 林曜祥(Yaoh-Shiang Lin)

《台灣耳鼻喉頭頸外科雜誌》 48卷1期 (2013/03) Pp. 13-20

https://doi.org/10.6286/2013.48.1.13

摘要

背景：聲帶麻痺為許多疾病的臨床表徵之一，其病因牽涉極廣且比例分布各異。本研究主要針對北部某醫學中心的聲帶麻痺住院患者進行病因分析。方法：從2000年6月到2011年12月，針對聲帶麻痺之住院患者的病歷紀錄做回溯性整理，以得其病因資料。結果：本研究共得555名患者的聲帶麻痺病因，其中316名男性、239名女性，單側麻痺490例、雙側麻痺65例。分析單側聲帶麻痺的病因，手術佔43.0%、腫瘤佔32.2%、不明原因佔10.4%、創傷佔5.7%、中樞性佔2.9%、放射線治療佔2.9% 、發炎佔1.6%及心血管相關疾病佔1.2%；另分析雙側聲帶麻痺的病因，手術佔44.7、不明原因佔13.8%、創傷佔12.3%、腫瘤佔9.2%、中樞性佔9.2%、放射線治療6.2%、發炎佔3.1%及心血管相關疾病佔1.5%。在手術導致的單側及雙側聲帶麻痺中，甲狀腺手術皆為最常見的病因，分別為119例及26例。腫瘤導致之聲帶麻痺則以肺癌最常見，共64例。在316名男性聲帶麻痺的患者中，因腫瘤引起的共112例，為最常見的病因；但在239名女性患者中，最常見病因則為手術，共131例。結論：手術是罹患聲帶麻痺的住院病人中最主要的致病因素，其中以甲狀腺手術引起的最常發生。診斷不明原因的聲帶麻痺之前，必須先排除腫瘤的可能性。除癌症外，良性的腫瘤如甲狀腺腫瘤亦可造成聲帶麻痺。對於放射線治療後的頭頸癌患者，須考慮放射線引起聲帶麻痺之可能性。

關鍵字

喉返神經 ； 聲帶麻痺 ； 病因 ； 甲狀腺手術

並列摘要

BACKGROUND: Vocal cord paralysis (VCP) is a sign of a certain underlying disease, a diagnosis which can be attributed to various causes. This study intends to analyze the contemporary etiology of hospitalized patients' VCP in a tertiary medical center.MATERIALS AND METHODS: A retrospective review of medical records from June 2000 to December 2011 of hospitalized patients with VCP was done to determine the etiology.RESULTS: Five hundred and fifty-five patients with a determined etiology were identified, consisting of 316 males and 239 females. Unilateral VCP was present in 490 patients, while 65 presented with bilateral VCP. The causes were surgical in 43.0%, neoplastic in 32.2%, idiopathic in 10.4%, traumatic in 5.7%, central in 2.9%, radiationinduced in 2.9%, inflammatory in 1.6%, and cardiovascular in 1.2% of the cases with unilateral VCP. Otherwise, the causes were surgical in 44.7%, idiopathic in 13.8%, traumatic in 12.3%, both neoplastic and central in 9.2%, radiation-induced in 6.2%, inflammatory in 3.1%, and cardiovascular in 1.5% of the patients having bilateral VCP. Thyroidectomy represented the most common surgery for VCP and was the cause in 145 patients. Lung cancer was responsible for 64 cases and was the most common neoplastic etiology. In males, neoplasm was the most common cause occurring in 112 of 316 males, whereas surgery was most frequent in 131 of 239 females.CONCLUSIONS: Surgical trauma, mainly thyroidectomy, is the most common cause of VCP in hospitalized patients. The possibility of a neoplasm must be ruled out before VCP is labeled idiopathic. A benign thyroid tumor could also cause VCP. Besides, radiation-induced cranial nerve paralysis should be considered in the patients of head and neck cancer who have undergone radiotherapy.

並列關鍵字

recurrent laryngeal nerve ； vocal cord paralysis ； etiology ； thyroid surgery