Bilateral Recurrent Laryngeal Nerve Paralysis Following Resection of Esophageal Carcinoma : Case Report
| Autor: | Koyama, Yoshito, Magara, Jin, Taniguchi, Hiroshige, Kurita, Hiroshi, Inoue, Makoto |
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| Jazyk: | japonština |
| Rok vydání: | 2014 |
| Předmět: | |
| Zdroj: | 新潟歯学会雑誌. 44(1):33-36 |
| ISSN: | 0385-0153 |
| Popis: | 症例は56歳男性で2012年12月頃に嚥下時のつかえ感を自覚，新潟大学医歯学総合病院消化器外科を受診し，進行性食道癌(T3N0M0 StageⅢ)の診断にて，2013年4月に右食道切除・3領域郭清術施行した。術後両側反回神経麻痺を生じ気管切開術施行，術後14日目に経口摂取再開目的に摂食嚥下回復部を受診した。初診時機能評価では，嗄声を認め，発声持続時間6秒，改定水飲みテストは3a点であった。嚥下内視鏡検査では，両側声門の正中固定，両側喉頭披裂の不全麻痺および嚥下時のホワイトアウト不良を認めたため，両側反回神経麻痺・咽頭圧形成不全を伴う嚥下咽頭期障害と診断した。間接訓練として，息こらえ訓練，プッシング訓練，直接訓練として，1%とろみ水を用いた訓練を開始した。訓練開始後7日目，嚥下造影検査施行し，液体での喉頭侵入，全粥・混合食にて咽頭残留が認められたが，複数回嚥下で誤嚥像なくクリアランスを保てた。以上の結果から，液体とろみ付け，全粥・半固形食(ペースト食)にて食事を開始した。その後嚥下間接訓練の継続，及び段階的な食上げを実施し，訓練開始後25日で経過良好につき自宅退院・外来通院となった。訓練開始後49日目の嚥下造影検査では，食道入口部直下の狭窄，食塊停滞を認め，消化器外科にて食道拡張術を施行，再評価し通過障害は改善した。吻合部位の食道停滞の再発が認められてはいるものの，現在も当科外来通院を1ヶ月単位で継続し，咽頭期の嚥下機能に関しては経過良好である。 The present case was 56 years old male patient, who felt difficulty swallowing as early subjective symptom, and consulted digestive surgery in Niigata University Medical and Dental Hospital in December 2012. The diagnosis was progressive esophagus cancer (T3N0M0 StageⅢ) and right esophagectomy and 3-field lymph node dissection surgery were performed in April 2013. After the operation, the dyspnea caused by the bilateral recurrent laryngeal nerve paralysis was observed and tracheostomy was undergone. The patient was admitted to the Unit of Dysphagia Rehabilitation on the 14th day after the operation. The first examination of swallowing function showed the dysarthria with shortened maximum phonation time. The modified water swallow test score was 3a. In the endoscopic examination, the bilateral glottis and arytenoid represented paresis and whiteout during swallowing was weakened. The diagnosis was dysphagia in the pharyngeal stage caused by the bilateral recurrent laryngeal nerve paralysis. Supraglottic swallow and pushing exercise were conducted as the indirect therapy; in addition, thickened water swallowing was also tasked as the direct one. The videofluoroscopic examination showed the penetration during liquid swallowing. Although the pharyngeal residue after solid food swallowing also remained, the clearance in the pharyngeal region was accomplished by added swallowing. Therefore，direct therapy was started using the adjusted meal. After swallowing function was improved, the fine progress admitted to leave the hospital on the 25th day. On the 49th day after therapy started, the videofluoroscopic evaluation showed the bolus stasis. After the esophagus extension was performed in digestive surgery, the videofluoroscopic assessment showed improvement of bolus stasis. Although the stasis at the anastomosis was still observed, the status of swallow function showed satisfactory and stable. |
| Databáze: | OpenAIRE |
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