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目的:探讨以突发声带麻痹为首发症状的甲状腺恶性肿瘤的临床特点,分析诊断、治疗过程中的注意点,避免漏诊、误诊。方法:对我科1999年2月~2003年2月收治的5例以突发声带麻痹为首发症状的甲状腺恶性肿瘤患者的临床资料进行回顾性分析。结果:5例病理检查均证实为甲状腺乳头状腺癌,4例侵犯一侧喉返神经致声带麻痹,术中分离喉返神经后行患侧腺叶切除,其中3例术后6个月内恢复正常的声带外展及内收功能,1例对侧声带代偿,声音嘶哑好转;1例肿瘤先侵犯右侧喉返神经致声带麻痹,1年后肿瘤侵入喉内引起双侧环杓关节固定,声音嘶哑加重,出现呼吸困难,先行患侧腺叶切除加半喉切除,术后3个月复发,又行全喉切除,随访2年无复发。结论:对于突发声带麻痹,同侧甲状腺占位,排除其他部位病变者,建议手术探查甲状腺,术中暴露喉返神经并加以保护,术中快速冷冻切片,根据病理检查结果决定手术范围。
Objective: To investigate the clinical features of thyroid malignant tumor with sudden vocal cord paralysis as the first symptom, to analyze the points of attention during diagnosis and treatment and to avoid misdiagnosis and misdiagnosis. Methods: The clinical data of 5 patients with thyroid malignant tumor who had sudden vocal cord paralysis admitted from February 1999 to February 2003 were analyzed retrospectively. Results: Five cases of pathological examination confirmed thyroid papillary adenocarcinoma, 4 cases of recurrent laryngeal nerve caused by vocal cord paralysis, intraoperative resection of the recurrent laryngeal nerve in patients with ipsilateral lobectomy, of which 3 cases within 6 months after surgery One case of contralateral vocal cords compensated with hoarseness improved; one case of tumor invaded the right recurrent laryngeal nerve caused vocal cord paralysis, and one year later the tumor penetrated the larynx to cause the bilateral cricoarytenoid joint Fixed, hoarseness increased, breathing difficulties, the first ipsilateral lobectomy plus half laryngectomy, 3 months after the recurrence, and line total laryngectomy, no recurrence after 2 years of follow-up. Conclusion: For sudden vocal cord paralysis, ipsilateral thyroid gland occupancy, exclude other parts of the lesions, it is recommended surgical exploration of the thyroid gland, intraoperative exposure of recurrent laryngeal nerve and protection, rapid intraoperative frozen section, according to the pathological findings determine the scope of the operation.