单侧声带麻痹为首发症状的甲状旁腺腺瘤1例并文献复习

doi:10.6040/j.issn.1673-3770.0.2022.476

摘要/Abstract

摘要： 目的探讨以单侧声带麻痹为首发症状的甲状旁腺腺瘤(parathyroid adenoma, PA)的临床诊疗及预后,为早期准确诊断及治疗提供依据。方法回顾性分析1例以单侧声带麻痹为首发症状的PA患者的临床资料,并结合相关文献进行分析讨论。结果喉返神经损伤可由良性甲状旁腺腺瘤压迫引起,而以单侧声带麻痹为首发症状的甲状旁腺腺瘤属实罕见且难以发现。当PA位于甲状腺背叶中下份并甲状腺下动脉分支入腺体的位置时,喉返神经可被卡压在之间引起神经水肿,导致声带麻痹。通过主客观嗓音评估及术前、术后喉肌电图证实,准确的诊断与及时切除甲状旁腺腺瘤,行喉返神经减压术可使神经功能及声带运动恢复正常。同时,术后患者的甲状旁腺激素和血钙水平均可恢复正常。结论 PA导致喉返神经功能异常较为少见,因而当单侧声带麻痹为首发及唯一症状时,易造成PA误诊或漏诊。单侧声带麻痹患者如发现甲状旁腺良性肿瘤,尤其是肿瘤位于甲状腺背叶中下份并甲状腺下动脉分支入腺体位置时,要考虑到良性肿瘤压迫喉返神经而使其功能受损的可能,及时的手术切除并神经减压是最佳治疗方案。

关键词: 甲状旁腺腺瘤, 单侧声带麻痹, 嗓音评估, 喉返神经

Abstract: Objective To investigate the clinical diagnosis, treatment, and prognosis of parathyroid adenoma(PA)with unilateral vocal cord paralysis as the first symptom and to facilitate accurate diagnosis and proper treatment. Methods The clinical data of one patient with unilateral vocal cord paralysis as the initial manifestation of PA were retrospectively analyzed, along with a review and discussion of the relevant literature. Results Recurrent laryngeal nerve injury can be caused by benign parathyroid adenoma compression. However, unilateral vocal cord paralysis as the initial and only manifestation of parathyroid adenoma is rare and difficult to detect. Parathyroid adenoma located in the middle-lower region of the dorsal thyroid lobe and the inferior thyroid artery may sandwich and pinch the recurrent laryngeal nerve, causing nerve swelling and, subsequently, vocal cord paralysis. Subjective and objective voice evaluation, in combination with laryngeal electromyography before and after the operation, revealed that accurate diagnosis, timely PA resection, and decompression of the recurrent laryngeal nerve can rescue nerve function and vocal cord movement. Additionally, these interventions can revert patient parathyroid hormone and blood calcium levels to normal. Conclusion PA rarely damage the recurrent laryngeal nerve. When unilateral vocal cord paralysis is its first and only symptom, PA can be easily misdiagnosed or remain undiagnosed. In patients with unilateral vocal cord paralysis, if a benign parathyroid tumor is found, the possibility of benign tumor compression and recurrent laryngeal nerve dysfunction should be considered, especially if the tumor is located in the middle-lower region of the dorsal thyroid lobe, where the inferior thyroid artery branches into the gland. Timely surgical resection and nerve decompression are the best choices of treatment.

Key words: Parathyroid adenoma, Unilateral vocal cold paralysis, Acoustic analysis, Recurrent laryngeal nerve

中图分类号:

R736.2

王婷玉,吕正华,韩茜茜,孙臻,张海燕,徐伟. 单侧声带麻痹为首发症状的甲状旁腺腺瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(1): 59-65.

WANG Tingyu, LÜ Zhenghua, HAN Qianqian, SUN Zhen, ZHANG Haiyan, XU Wei. Unilateral vocal cord paralysis as the initial manifestation of parathyroid adenoma: a case report and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(1): 59-65.

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