頸椎前位手術後之吞嚥障礙：病例報告

吞嚥障礙爲頸椎前位手術的併發症之一，有許多可能的致病原因。在臨床上，一般是短暫的症狀，僅少數病人的吞嚥障礙症狀會持續數個月以上。本研究報告一名頸椎第五、六節脫位性骨折患者於接受頸椎前位手術後，持續有吞嚥障礙的症狀達半年之久。經電視螢光錄影吞嚥檢查發現有咽喉肌無力、環咽肌放鬆不足及左側阻塞現象。喉部內視鏡檢查並無發現聲帶麻痺等器質性病變。核磁共振檢查亦無腦損傷的情形。我們推測本病例發生吞嚥障礙的可能原因，一爲咽喉神經叢的神經纖維或附近神經肌肉交接處受傷所致。另外手術放置的金屬板與咽喉壁軟組織之間，在傷口癒合後或許有沾黏，造成環咽肌無法順利在吞嚥反射過程中放鬆而導致吞嚥障礙。本報告亦論及一個未被提出可能造成吞嚥障礙的因素，即爲吞嚥呼吸暫停(deglutition apnea)現象。本個案的肺功能檢查顯示有重度侷限性肺病，因此在吞嚥時的呼吸暫停動作，會特別在垂直坐姿時讓病患感到喘不過氣，也導致吞嚥困難的主訴。

關鍵字

吞嚥障礙；頸椎前位手術；環咽肌；咽喉神經叢；吞嚥呼吸暫停

並列摘要

Dysphagia is one of the complications that develops after anterior cervical spine surgery. Its etiology is multifactorial. It is transient in most patients, and few patients suffer from dysphagia for more than several months. This study reports 1 patient with a dislocation fracture at the C5-C6 level who suffered from dysphagia for 6 months after the anterior cervical spine surgery. Videofluoroscopic examination of swallowing revealed pharyngeal muscle weakness and cricopharyngeal muscle dysfunction with obstruction at the level of the left upper esophageal sphincter. Serial examination revealed neither laryngeal organic lesions, such as those observed in vocal cord palsy, nor evidence of brain injury. The probable cause of dysphagia in this patient may be the injury to the neuromuscular junction or fibers of the pharyngeal plexus, and the adhesion of the anterior cervical plate to the surrounding soft tissue. Another possible reason causing dysphagia in this patient is deglutition apnea, which has not been reported earlier. Deglutition apnea might cause dyspnea in patients with severe restrictive lung disease, especially when they sit upright, and worsen the swallowing function.

並列關鍵字

dysphagia ； anterior cervical spine surgery ； cricopharyngeal muscle ； pharyngeal plexus ； deglutition apnea

國際替代計量

頸椎前位手術後之吞嚥障礙：病例報告

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