以左側聲帶麻痺為表徵之胸主動脈瘤

Left Vocal Palsy as the Presenting Sign of Thoracic Aortic Aneurysm

場宗翰(Tsung-Han Yang) ； 趙品植(Pin-Zhir Chao) ； 李飛鵬(Fei-Peng Lee) ； 李宏生(Hong-Sheng Lee)

《台灣耳鼻喉頭頸外科雜誌》 38卷s_1期 (2003/01) Pp. 63-67

https://doi.org/10.6286/2003.38.s_1.63

摘要

聲帶麻痺是一個徵候而不是一個疾病，它可以由許多疾病所引起。其中由胸主動脈瘤所引起者，只有約百分之一到三。通常胸主動脈瘤是沒有任何症狀的，如果出現像是胸痛、胸骨下痛、背痛、或是頸部疼痛等疼痛的症狀，就是胸主動脈瘤在擴張或是瀕臨破裂的訊號。若是周圍組織或器官受其壓迫或侵蝕，則可以產生如聲音嘶啞、咳嗽、呼吸困難、咳血、吞嚥困難、頸部及上臂水腫等等的症狀。因為傳統式外科手術治療具有相當高的危險性，小而無症狀的主動脈瘤通常給予藥物治療及追蹤。手術的適應症為大於6cm或是有症狀或是持續擴大的主動脈瘤。1990年代開始發展出新的手術方式，可以降低手術的危險性。本科於2002年6月經歷一例80歲男性病人，因為持續2周的聲音沙啞而前來本科就診。理學檢查時發現病人的左側聲帶麻痺。胸部X光檢查發現縱膈腔及主動脈球異常擴大。電腦斷層掃瞄診斷為約10cm大小之胸主動脈瘤。病患於接受外科手術治療後併發腦中風、肺炎及尿道感染等併發症。因為此病潛在之致命性實在不容輕忽，而新的手術方式則可望帶來較好的結果，因此可以彰顯早期診斷的重要性及胸部X光檢查的價值，故提出報告，並討論其病因、臨床表現、治療方式及預後。

關鍵字

聲帶麻痺 ； 胸主動脈瘤

並列摘要

Vocal palsy is not a disease entity but a sign of many diseases. Among them, thoracic aortic aneurysms constitute only about 1 to 3%. Mostly, the aneurysms don't produce symptoms or signs, but when they do, they are surgically indicated. When the aneurysms are expanding or are large enough to compress to or erode adjacent structures like bronchus, the left recurrent laryngeal nerve, esophagus, or superior vena cava, they can produce symptoms and signs like chest pain, cough, dyspnea, hemoptysis, hoarseness, dysphagia, pulsatile mass, cardiac murmur, vocal palsy, etc. Indications for surgery are aneurysms larger than 6cm, expanding, or symptomatic. Conventional thoracotomic aneurysmal resection with prosthetic vascular graft carries high surgical mortality and morbidity while new technique developed since 1990's using transluminal endovascular stent graft is safer and having a better result. We experienced a case that suffered from hoarseness for 2 weeks prior to visiting our clinic. Left vocal palsy was noted and roentgen examinations showed a saccular thoracic aortic aneurysm about 10cm in size located at the aortic arch. Conventional cardiovascular surgery was performed and was complicated by stroke, pneumonia, and urinary tract infection. Although it's potentially highly lethal, new surgical technique is promising for a better outcome. Thus, these can highlight the importance of early diagnosis and the value of chest X-rays.

並列關鍵字

vocal palsy ； thoracic aortic aneurysm