引起單側聲帶麻痺之食道癌

Unilateral Vocal Palsy Induced by Esophageal Cancer

陳建志(Jiann-Jy Chen) ； 陳瑞昌(Jeil-Chung Chen) ； 莊子儀(Tzu-Yi Chuang) ； 楊菁華(Chin-Hua Yang) ； 陳登郎(Dem-Lion Chen)

《北市醫學雜誌》 5卷3期 (2008/06) Pp. 395-399

https://doi.org/10.6200/TCMJ.2008.5.3.08

摘要

食道癌初期的症狀並不明顯，主要是吞嚥困難或體重減輕。一47歲男性病患，突發左側聲帶麻痺2星期，當時胸部X光並無異常發現；5個月後才開始吞嚥困難，胸部X光及電腦斷層呈現上縱膈腔的病灶，上消化道內視鏡檢顯示食道中段處的腫瘤，組織病理報告為腺癌，腹部超音波顯示疑似右側腎上腺轉移，最後診斷為T4N0M1，第IV期食道癌，建議化學放射合併治療；不料，2週後突然大量吐血休克後死亡。因此，建議聲帶麻痺患者，就算是病史回顧、理學檢查及胸部X光均無異樣者，尚需考慮安排頭頸胸的電腦斷層及上消化道內視鏡檢，特別是對於抽菸酗酒者，或無明顯病因卻未自行恢復者。特報告該病例，除了罕見外，亦為警惕。

關鍵字

單側聲帶麻痺 ； 食道腺癌

並列摘要

The early presentat ion of esophageal malignancy is always negligible, predominately dysphagia or body weight loss. A 47-year-old male patient presented with sudden left vocal palsy for 2 weeks. Chest X-ray (CXR) revealed normal. After 5 months, dysphagia began to bother him, and CXR and computed tomography (CT) revealed an obvious mass lesion in the superior mediastinum; upper gastrointestino-scopy (UGI scopy) showed a tumor in the middle esophagus, and pathologic study reported adenocarcinoma; abdomen ultra-sonography showed a suspected metastasis in the right adrenal gland; therefore, the esophageal malignancy was staged T4N0M0, stage Ⅳ. He was scheduled for concurrent chemotherapy/radiotherapy; however 2 weeks later, he died of massive hematemesis. In conclusion, head-neck-chest contrasted CT and UGI scopy are recommended for vocal palsy despite of delicate history-review, normal physical examinations and normal CXR, especially for a cigarette smoker or alcohol drinker, or un-recovery without a significant cause. Herein we present the rare case as a warning.

並列關鍵字

unilateral vocal palsy ； esophageal malignancy