Deslypere G, Cuppens K, Pat K, Aumann J, Demuynck K, Spaas L
University Hospitals Leuven, Dept. of Respiratory Medicine, Herestraat 49, 3000 Leuven, Belgium.
Jessa Hospital Hasselt, Dept. of Respiratory Medicine and Thoracic Oncology, Stadsomvaart 11, 3500 Hasselt, Belgium.
Respir Med Case Rep. 2015 Sep 11;16:140-2. doi: 10.1016/j.rmcr.2015.09.003. eCollection 2015.
We describe a patient with acute respiratory insufficiency and difficult ventilator weaning in the ICU ward, leading to diagnosis of small cell lung cancer with superior vena cava superior syndrome. Bilateral vocal cord paralysis caused his respiratory distress and weaning difficulties. Thyroidectomy and neurological problems (such as Parkinson disease and Guillain Barré syndrome) are more common causes of bilateral vocal cord paralysis. Lung cancer patients are also at risk due to mediastinal invasion. The left recurrent laryngeal nerve is more prone to paralysis because of the typical anatomy. In contrary, bilateral vocal cord paralysis is rare and doesn't result in speech problems but rather breathing difficulties. Tracheostomy is the classic therapy, but laser cordectomy and Botulinum toxin injection in the laryngeal muscles are alternatives.
我们描述了一名在重症监护病房出现急性呼吸功能不全且呼吸机撤机困难的患者，最终诊断为小细胞肺癌伴上腔静脉综合征。双侧声带麻痹导致其呼吸窘迫和撤机困难。甲状腺切除术及神经问题（如帕金森病和吉兰 - 巴雷综合征）是双侧声带麻痹更常见的原因。肺癌患者由于纵隔侵犯也有发生双侧声带麻痹的风险。由于典型的解剖结构，左侧喉返神经更易发生麻痹。相反，双侧声带麻痹很少见，不会导致言语问题，而是引起呼吸困难。气管切开术是经典的治疗方法，但激光声带切除术和向喉肌注射肉毒杆菌毒素也是可选择的治疗方法。
