Ishii Kosuke, Adachi Hideo, Tsubaki Keiju, Ohta Yasushi, Yamamoto Masanori, Ino Takashi
Department of Otorhinolaryngology, Omiya Medical Center, Jichi Medical School, 1-847 Amanuma-cho, Saitama-shi, Saitama 330-8503, Japan.
Laryngoscope. 2004 Dec;114(12):2176-81. doi: 10.1097/01.mlg.0000149453.91005.ab.
We sought to clarify the relationship between the outcome of recurrent laryngeal nerve paralysis with the characteristics of the thoracic aortic aneurysm and the surgical procedure used in each patient.
Nine patients who developed recurrent nerve paralysis (nonsurgical paralysis) due to a thoracic aortic aneurysm alone and 14 patients who underwent artificial vessel replacement for thoracic aortic aneurysm and developed recurrent nerve paralysis postoperatively (surgical paralysis) were evaluated.
In the patients with nonsurgical paralysis, the aneurysms were similar in size to those of other patients who underwent surgery of the thoracic aorta and were invariably located near the aortic arch. Aneurysm shape was not associated with nerve paralysis. Surgical paralysis was alleviated in two patients. Surgical paralysis was observed in 9% of those who underwent surgery of the thoracic aorta. Vocal cord mobility recovered in 4 of the 11 patients with surgical paralysis who underwent follow-up. Symptoms were alleviated by rehabilitation in many patients who did not recover vocal cord mobility. The positions of the artificial vessel anastomoses are thought to be closely related to the outcome of paralysis.
Recurrent nerve paralysis reduced not only the patient's quality of life but also survival by leading to disorders including aspiration pneumonia. Therefore, early rehabilitation should be performed, and surgical treatment should be considered, if necessary, for patients with recurrent nerve paralysis.
我们试图阐明喉返神经麻痹的预后与胸主动脉瘤的特征以及每位患者所采用的手术方法之间的关系。
对9例仅因胸主动脉瘤而发生喉返神经麻痹（非手术性麻痹）的患者以及14例接受胸主动脉瘤人工血管置换术且术后发生喉返神经麻痹（手术性麻痹）的患者进行了评估。
在非手术性麻痹患者中，动脉瘤大小与其他接受胸主动脉手术的患者相似，且均位于主动脉弓附近。动脉瘤形状与神经麻痹无关。两名患者的手术性麻痹得到缓解。在接受胸主动脉手术的患者中，9%出现了手术性麻痹。在接受随访的11例手术性麻痹患者中，4例声带活动恢复。许多声带活动未恢复的患者通过康复治疗症状得到缓解。人工血管吻合部位被认为与麻痹的预后密切相关。
喉返神经麻痹不仅降低了患者的生活质量还导致包括吸入性肺炎等疾病，进而影响生存。因此，对于喉返神经麻痹患者应尽早进行康复治疗，必要时应考虑手术治疗。
