侵入喉氣管之甲狀腺增生－病例報告

喉氣管內甲狀腺在臨床上相當少見，文獻記載迄今僅約120多例，且幾乎全出現在易發生地區流行性甲狀腺結節的中歐國家，英文文獻僅約報告過20例。本院於1998年經歷一病例，病人為52歲女性，主訴呼吸困難及呼吸短促有4年之久，曾於多處求診均診斷為支氣管氣喘，但病人經服用氣管擴張劑等藥物後症狀均無明顯改善，在一次切除鼻部皮膚腫塊的手術中，插管時發現病人有聲門下狹窄的情形而轉介至本院。以軟式喉頭內視鏡檢查，發現病人聲門下區有一突起腫塊幾乎佔據了大部分的呼吸道，核磁共振檢查發現在環狀軟骨附近有一2 x 1.5 x 1 cm的腫瘤突出於右側聲門下區域並造成嚴重之聲門下狹窄，懷疑為甲狀腺癌併聲門下侵犯。病人經頸部切開，將第一、第二氣管軟骨及部分環狀軟骨連同氣管內腫瘤一起切除，並施行甲狀氣管吻合術（thyrotracheal anastomosis）重建缺損之上呼吸道。病理報告證實氣管內腫瘤為良性之甲狀腺結節。術後病人發生右側聲帶麻痺，經聲帶內鐵弗龍注射後情況良好，門診追蹤至今3年，無腫瘤復發跡象。喉氣管內甲狀腺是造成呼吸道阻塞非常少見的原因，臨床醫師必須了解，並將其列入鑑別診斷之中，才能作出正確的檢查及治療，而不致延誤病情。

關鍵字

喉氣管內甲狀腺；聲門下狹窄；呼吸困難

並列摘要

Intralaryngotracheal thyroid is a rare clinical condition with only 127 cases described in the literature. Most of these patients were found in the endemic goiter zones of the middle-European countries. In 1998, we treated a 52-year-old female who presented with a four-year history of dyspnea and shortness of breath. The patient had visited many hospitals and was diagnosed with bronchial asthma. The symptoms did not improve after adequate use of bronchodilators, however. Subglottic stenosis was accidentally discovered during intubation for excision of a nasal skin tumor, and the patient was transferred to our hospi-tal after the surgery. Fiber- laryngoscopy revealed an upper tracheal submucosal mass occluding most of the airway. A tumor mass (2.0 x 1.5 x 1.0 cm) occupying the right subglottic and upper tracheal region was evident on MRI. The intralaryngotracheal tumor was excised with partial resection of the cricoid cartilage and the first and second tracheal rings. The pathological diagnosis for the intralaryngotracheal tumor was nodular goiter. Right-side vocal cod palsy was noted after surgery and Teflon was injected intracordally for salvage treatment. At the time of writing, the patient had done well for over three years, with no recurrent intralaryngotracheal thyroid tissue noted following surgery. Clin-icians must remain aware of the fact that thyroid tissue may occur in this location, so that appropriate diagnostic studies and surgical management can be instituted.

並列關鍵字

intralaryngotracheal thyroid ； subglottic stenosis ； dyspnea

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侵入喉氣管之甲狀腺增生－病例報告

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