頸椎前位式椎間盤切除術後嚴重吞嚥障礙：病例報告

Severe Dysphagia Following the Anterior Surgical Approach to the Cervical Spine : A Case Report

裴松毅(Sung-Yi Pei) ； 王邦元(Pong-Yuen Wong) ； 昝文清(Wen-Ching Tzaan) ； 黃韻筑(Yuen-Chu Huang) ； 陳智光(Chih-Kuang Chen)

《中華民國復健醫學會雜誌》 30卷1期 (2002/03) Pp. 57-62

摘要

對於頸椎病患而言，前位式椎間盤切除術（anterior discectomy）是神經外科醫師常用的手術方法。術後常見的合併症有發音障礙及吞嚥障礙，但大部份都呈短暫性且程度輕微。本文報告一個案第三、四節頸椎骨刺經前位式椎間盤切除術後，發生嚴重之吞嚥困難及右側舌肌萎縮。電視螢光錄影檢查發現患者環咽肌弛緩不能，併有吸入現象。病患先以鼻胃管灌食維持必要之營養並接受復健治療。經過三個月後，病患有明顯之進步，可進食常規之飲食。造成該病患術後吞嚥困難的可能原因，經排除血腫壓迫、組織水腫和感染後，推測為咽神經叢損傷。環咽肌功能失調治療方法包括曼德森手法、環咽肌切開術、氣球擴張術、肉毒桿菌毒素注射等。本病例以曼德森手法就得到極佳效果。我們提出此一罕見嚴重吞嚥困難病例，希望藉由相關文獻的討論，對此一術後可能之合併症有完整的瞭解。

關鍵字

吞嚥困難 ； 頸椎 ； 術後合併症

並列摘要

The anterior approach is popularized among neurosurgeons for operative exposure of the cervical spine. However, neurological complications of this approach are not uncommon, and little research had been performed regarding the etiology and optimal treatment. The common complications include dysphonia and mild dysphagia. The etiologies of dysphagia following the anterior approach are: (1) hematoma formation, (2) intraoperative tissue damage with subsequent edema, (3) infection, and (4) denervation. Videofluoroscopic examination of swallowing is the most common measurement of cricoph-aryngeal dysfunction; manometry is also used, but to a lesser degree. For cricopharyngeal achalasia, there are five approaches to manage, including: (1) Mendelsohn’s maneuver, (2) the external technique to myotomy, (3) the endoscopic approach, (4) balloon dilation of the cricopharyngeus, (5) botulinum toxin injection of the cricopharyngeus percutaneously or endoscopically.
This case was a 63-year-old male patient who suffered from severe dysphagia following anterior discectomy and instrument fixation due to C3-4 subluxation. Wasting of the paralysed right half of the tongue with deviation to right side was noted. Cricopharyngeal achalasia and aspiration after swallowing were confirmed with the videofluoroscopic examination. After 3 months, severe dysphagia was ameliora-ted by the Mendelsohn’s maneuver. We reported this case to discuss the etiology, diagnostic methods, and treatments about the dysphagia following the anterior approach to cervical spine.

並列關鍵字

dysphagia ； cervical vertebrae ； postoperative complications