手術相關與腫瘤相關單側聲帶麻痺之臨床與肌電圖差異

目的：單側聲帶麻痺(unilateral vocal fold paralysis)是造成患者發音異常與吞嚥障礙的常見原因。最常見的原因除手術傷害(surgery-related)外，尚包括自發性(idiopathic)、病毒感染、肺結核、放射線與腫瘤壓迫等。目前已知研究多著重手術造成單側聲帶麻痺或自發性單側聲帶麻痺等族群，較少著重於非手術且非自發性病因(non-surgical- non-idiopathic)等其它病因族群特色。而非手術且非自發性病因族群中，腫瘤相關聲帶麻痺是主因之一，尤以頭頸部與胸腔腫瘤最為常見。因此，本研究採回溯性分析，腫瘤相關之聲帶麻痺族群在臨床表現、肌電圖與生活品質量表上是否具特異性，並與臨床最常見之手術相關單側聲帶麻痺患者比較差異，以期結果可做為臨床診斷與治療計畫擬定之參考依據。設計：橫斷式研究。方法：利用喉部肌電圖儀記錄兩側甲杓-側環杓複合肌群(TA-LCA musclecomplex, thyroarytenoid muscle=TA muscle；lateral cricoarytenoid muscle= LCA muscle)和環甲肌(cricothyroid muscle, CT muscle)之肌電圖分析。採用生活品質三十六題簡短版量表(Short Form-36 quality -of-life questionnaire) 評估生活品質受影響層面及程度，並比較腫瘤相關組與手術相關組兩組之差異。結果：本研究共分析138 位病患，4 位因SF-36 生活品質量表資料及1 位因肌電圖資料未完整而排除。所餘133 位病患依病因分為兩組:手術相關組(119 人)及腫瘤相關組(14 人)。族群特色分析顯示，腫瘤相關組(右側/左側=1/13)相較於手術相關組(右側/左側:45/74)有更高的左側聲帶偏癱比例(p=0.034)。各組內分布顯示，手術相關組以甲狀腺手術所占比例最高(56%)；腫瘤相關組則以甲狀腺腫瘤最多(36%)。肌電圖結果顯示，兩組在自發性運動電位異常表現(p =0.54)、多相波表現 (p =0.52)、以及神經肌肉徵召減少(p =0.6)，皆沒有明顯統計上差異。生活品質三十六題簡短版量表次量表分析，腫瘤相關組相較手術相關組在一般健康狀況項目(60.7±18.8 vs 48.022.9; p =0.049)、身體生理問題角色受限(60.7±47.7 vs32.9±43.6; p =0.028)及身體疼痛量表項目(89.1±19.0 vs 76.1±23.2;p =0.032) 皆有明顯較佳的表現。結論：經本研究發現，腫瘤相關之單側聲帶麻痺患者相較於手術相關單側聲帶麻痺患者，有較高的左側受損比率，且在生活品質之一般健康狀況、身體疼痛、以及身體生理問題角色受限等面向，皆有較佳的表現。然而，兩組在肌電圖訊號上並無差異。故未來仍須要配合更進一步定量化肌電圖分析與影像學等的研究，來做為臨床參考依據。

關鍵字

單側聲帶麻痺(unilateral vocal fold paralysis) ；喉部肌電圖(laryngeal electromyography) ；手術傷害單側聲帶麻痺(surgery-related unilateral vocal fold paralysis) ；甲杓-側環杓複合肌群(thyroarytenoid muscle-lateral cricoarytenoid muscle complex) ；上喉神經(superior laryngeal nerve)

並列摘要

Background: The etiologies of unilateral vocal fold paralysis (UVFP) could be highly varied. It could be idiopathic or related to surgery, infection, radiation, and tumor. Among these causes of UVFP, surgery-related and idiopathic UVFP were the most well studied. However, the clinical characteristics of tumor-related UVFP have been discussed in only a few studies. Therefore, we evaluated the clinical and electromyographic characteristics of tumor-related UVFP and compared them with those of surgery-related UVFP. Methods: Laryngeal electromyography (LEMG) was performed in the thyroarytenoid-lateral cricoarytenoid muscle complexes and the cricothyroid muscles. The Short Form-36 quality-of-life questionnaire (SF-36) was applied to evaluate the patient’s quality of life. The LEMG and SF-36 findings were compared between the surgery-related and tumor-related groups. Results: Among the 138 patients recruited, five were excluded because of incomplete data collection. The remaining 133 patients were divided into the surgery-related (n=119) and tumor-related (n=14) groups. Patients in the tumor-related group (right/left=1/13) had a significantly higher proportion of left vocal fold involvement than did the patients in the surgery-related group (right/left=45/74). Subgroup analysis revealed that thyroid surgery (56%) and thyroid tumor (36%) were the leading causes of UVFP in the surgery-related and tumor-related groups, respectively. LEMG showed no significant differences in the proportion of spontaneous activity (p=0.54), polyphasia (p=0.52), and recruitment (p=0.6) between the two groups. SF-36 findings showed that the tumor-related group had significantly higher scores than the surgery-related group in general health perceptions (60.7±18.8 vs 48.022.9; p=0.049), role limitations due to physical health (60.7±47.7 vs 32.9±43.6;p=0.028), and bodily pain (89.1±19.0 vs 76.1±23.2;p=0.032). Conclusion: Compared to patients with surgery-related UVFP, patients with tumor-related UVFP have a distinct clinical presentation with a higher percentage of left-sided vocal fold involvement and a less negative impact on quality of life. Patients in the tumor-related group also had better life quality indices such as general health perceptions, role limitations due to physical health, and bodily pain score. LEMG characteristics might not be useful in differentiating tumor-related and surgery-related UVFP.

並列關鍵字

unilateral vocal fold paralysis ； laryngeal electromyography ； surgery-related unilateral vocal fold paralysis ； thyroarytenoid muscle-lateral cricoarytenoid muscle complex ； superior laryngeal nerve

參考文獻

Takano, S., T. Nito, N. Tamaruya, et al., Single institutional analysis of trends over 45 years in etiology of vocal fold paralysis. Auris Nasus Larynx, 2012. 39(6): p. 597-600.

Spataro, E.A., D.J. Grindler, and R.C. Paniello, Etiology and Time to Presentation of Unilateral Vocal Fold Paralysis. Otolaryngol Head Neck Surg, 2014. 151(2): p. 286-93.

Urquhart, A.C. and E.K. St Louis, Idiopathic vocal cord palsies and associated neurological conditions. Arch Otolaryngol Head Neck Surg, 2005. 131(12): p. 1086-89.

Amin, M.R. and J.A. Koufman, Vagal neuropathy after upper respiratory infection: a viral etiology? Am J Otolaryngol, 2001. 22(4): p. 251-6.

Richardson, B.E. and R.W. Bastian, Clinical evaluation of vocal fold paralysis. Otolaryngol Clin North Am, 2004. 37(1): p. 45-58.

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手術相關與腫瘤相關單側聲帶麻痺之臨床與肌電圖差異

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