伴有術前喉返神經麻痺的甲狀腺腫瘤

Thyroid Tumors with Preoperative Recurrent Laryngeal Nerve Palsy

林荏志(Jen-Chih Lin) ； 江豐裕(Feng-Yu Chiang)

《台灣耳鼻喉頭頸外科雜誌》 39卷2期 (2004/04) Pp. 59-64

https://doi.org/10.6286/2004.39.2.59

摘要

背景：甲狀腺腫瘤伴有術前喉返神經麻痺的病人並不常見，本研究針對此種病例惡性的機率、組織病理學的分佈、術中對周圍組織的侵犯以及患候的預後作分析。
方法：從1987年6月至2002年12月由作者親自處理過的521例甲狀腺手術中，有14例甲狀腺腫瘤伴有術前喉返神經麻痺。
結果：14例甲狀腺霎瘤伴有術前喉返神經麻痺的病人中，13例(92.9%)為惡性腫瘤；男性9例、女性4例；年齡分佈43到77歲，平均60歲；其中乳突狀腺癌6例(46.2%)、未分化癌4例(30.7%)、鱗狀上皮細胞癌3例(23.1%)。手術方式：4例施行全喉全甲狀腺切除併根治性頸淋巴廓清術、4例施行全甲狀腺切除併部份上呼吸消化道的切除、另6例施行全甲狀腺切除術。在14例甲狀腺腫瘤伴有術前喉返神經麻痺的病人中，3例喉返神經可以完整分離，其中2例於術後1個月聲帶恢復正常活動。
結論：伴有術前喉返神經麻痺的甲狀腺腫瘤暗示著高度惡性的可能。本研究中13例惡性甲狀腺腫瘤中分化良好的甲狀腺癌僅佔46.2%。平均年齡偏高。57.1%的病人有上呼吸消化道的侵犯。此類病人術前應詳細評做腫瘤侵犯的範圍，不管腫瘤的大小都應做斷層抓描，全甲狀腺切除應是至少的手術，本研究有57.1%的病人需施行部份上呼吸消化道的切除或全喉切除術。(台耳醫誌 2004;39:59-64)

關鍵字

聲帶麻痺 ； 甲狀腺癌 ； 喉返神經

並列摘要

BACKGROUND: We designed this study to define the relationship to malignancy incidence, histopathological distribution, extrathyroid invasion, and prognosis of recurrent laryngeal nerve palsy that occurs prior to surgery for thyroid neoplasm.
METHOD: Charts were reviewed of 521 patients who, between June 1987 and December 2002, had surgery for thyroid neoplasm performed by the author of this study at the Kaohsiung Medical University Hospital.
RESULTS: Fourteen patients, with 13 proven malignancy including 9 male and 4 female and ranging in age from 43 to 77 years, were diagnosed with recurrent laryngeal nerve palsy prior to surgery for thyroid neoplasm. Of these fourteen, 6 underwent total thyroidectomy only, 4 underwent total thyroidectomy and total laryngectomy with radical neck dissection, and 4 underwent total thyroidectomy with partial resection of the upper aerodigestive tract. Pathologist reports indicated that among the fourteen, 13suffered from thyroid cancers (92.9%), six (46.2%) of which were identified as papillary carcinoma, four (30.7%) of which as anaplastic carcinoma, and three (23.1%) of which as squamous cell carcinoma. Three patients had their recurrent laryngeal nerve successfully dissected from the thyroid neoplasm. Two of the three then experienced satisfactory recovery of vocal cord mobility postoperatively.
CONCLUSION: Recurrent laryngeal nerve palsy in association with thyroid disease is considered a malignancy until proven otherwise. Papillary cancer was identified in 46.2% of the 13 patients with a malignant thyroid neoplasm. Patients evaluated under preoperative CT scan with recurrent laryngeal nerve palsy with thyroid disease should be treated using total thyroidectomy. Resection of the infiltrated upper aerodigestive tract may also be advised due to the high incidence of local invasion in such patients, which total laryngectomy may be required. (J Taiwan Otolaryngol Head Neck Surg 2004;39:59-64)

並列關鍵字

vocal cord paralysis ； thyroid cancer ； recurrent laryngeal nerve