迷走神经损伤定位检查有助于单侧声带麻痹的病因诊断

目的探讨迷走神经损伤定位检查用于单侧声带麻痹病因诊断中的价值。方法对1例半年未能明确病因的单侧声带麻痹患者的诊疗过程进行回顾分析。结果本例因声音嘶哑半年就诊,在当地多家医院行相关医技检查均诊断为左侧特发性声带麻痹,予相应治疗症状无改善,来我院拟行声带自体脂肪注射术闭合声门。入我院后经追问病史、仔细查体及电子喉镜下吞咽功能检查发现左侧梨状窝有食物残留,考虑迷走神经节以上部位病变所致声带麻痹,经颅底增强MRI检查诊断为颈静脉孔区良性肿瘤。由于病变部位特殊,患者拒绝手术遂行伽马刀治疗,随访1年,肿瘤无变化。结论对于单侧声带麻痹患者切勿轻易诊断为单纯声带麻痹。电子喉镜下吞咽功能检查有助于确定迷走神经损伤部位,根据损伤部位有的放矢地进行检查,对单侧声带麻痹的病因诊断有临床指导价值。     

老年患者单侧声带麻痹32例临床分析

目的：探讨老年患者单侧声带麻痹的病因。方法：回顾性分析32例老年患者单侧声带麻痹的临床资料。结果：全身性恶性肿瘤是引起老年患者单侧声带麻痹的常见病因。结论：老年患者单侧声带麻痹者要警惕恶性肿瘤的可能，积极明确病因。     

复发性多软骨炎误诊为肺部感染及延髓麻痹

目的分析复发性多软骨炎(relapsing polychondritis,RP)误诊的原因,并提出防范误诊的对策。方法回顾性分析1例RP误诊病例的诊治经过。结果本例因反复发热伴咳嗽、咽痛、声嘶入院。病初在当地医院诊断为肺部感染,治疗后体温降至正常,但药物减量则再次出现发热。入我院后经完善相关检查诊断考虑延髓麻痹?脊髓空洞症早期?肺部感染?给予相应治疗效果不佳,患者渐出现双耳廓肿痛,皮温稍高,呈牛肉样红色。至上海某医院行全身骨扫描及耳软骨切片病理检查,确诊为RP,经治疗病情明显好转。结论 RP临床表现多种多样,且缺乏特异性检查方法,极易误诊和漏诊。对于临床怀疑RP者,应进行详细而全面的查体,密切观察患者耳、眼、气管等表现,并行软骨组织病理学检查助诊。     

临床应警惕以单侧声带麻痹为首发表现的纵隔转移癌

目的探讨老年声带麻痹的病因及诊断经验,以提高确诊率。方法对以单侧声带麻痹为首发表现的纵隔转移癌老年患者1例的临床资料进行回顾性分析。结果本例因突发声音嘶哑伴进流食呛咳3个月就诊,于当地医院诊断为左侧声带麻痹,予营养神经药物治疗无效转我院。下咽食管造影、胃镜及颈部、腹部超声均未见异常,经喉镜及胸部X线检查诊断为特发性单侧声带麻痹,行支撑喉镜下声带自体脂肪注射填充术,术后症状基本消失。4个月后因咳嗽、进食哽咽感复诊,经胸部CT、颈部超声及左锁骨上淋巴结穿刺活检病理检查确诊为纵隔转移癌。予纵隔及锁骨上淋巴结伽马刀治疗,1年后死亡。结论老年声带麻痹的首发病因是头颈及胸部肿瘤压迫迷走神经或喉返神经,应仔细询问病史、详细查体,完善头颈及胸部影像学检查,并密切随访,以免漏诊。     

浅谈声带麻痹124例分析

目的：探讨声带麻痹的病因及预防。方法：因顾性分析124例声带分析124例声带麻痹患者的临床资料。结果：喉外肿瘤引起73例，占首位，为58．9％：不明原因21例：外伤手术15例；感染、炎症14例：中毒性1例。经随访，声带功能完全恢复21例，占16．1％。结论：对声带麻痹患者要积极明确病因，重点应放在颈胸部肿瘤的检查上；积极治疗发病。     

鼻咽癌放疗后2年出现双侧声带麻痹1例报道

声带麻痹在临床上较为常见，病因复杂。患者表现为不同程度声音嘶哑、一侧或两侧声带固定或运动减弱。随着肿瘤、外伤发生率的增高，声带麻痹的发病率有升高趋势。病因主要有肿瘤、占位病变、手术损伤、创伤、脑血管意外等。常引起声嘶、误咽、呛咳，甚至不能进食。双侧声带麻痹还可造成喉梗阻，危及生命。我院于2007年4月收治1例鼻咽癌放疗后2年引起双侧声带麻痹患者，报道如下。     

跨声门喉癌一例长期误诊剖析

目的探讨跨声门喉癌长期误诊的原因,以提高早期诊断水平。方法对我院收治并误诊为声带麻痹长达2年的跨声门喉癌1例的临床资料进行回顾性分析。结果本例因声音嘶哑多次在外院就诊,纤维喉镜或电子喉镜检查均诊断为声带麻痹,后因声音嘶哑加重伴呼吸困难入我院。经增强CT、电子喉镜活检诊断为跨声门喉癌,行喉全切除+甲状腺切除+双颈淋巴结择区清扫术,术后恢复良好,随访1年未见肿瘤复发或转移。结论跨声门喉癌部位隐匿,可致声带固定,纤维喉镜或电子喉镜检查易误诊,提示临床接诊声带固定患者应及时行CT、MRI检查,以减少误诊误治。     

脑干脑炎临床及影像学特点研究

目的探讨脑干脑炎的临床及影像学特点,以减少临床误诊误治。方法回顾性分析15例脑干脑炎的临床资料。结果本组4例存在前驱感染病史,临床常见症状为头晕、步态不稳,相对特异症状为呃逆及延髓性麻痹;病灶以侵犯脑桥、延髓为主;脑脊液检查缺乏典型表现,压力轻度升高2例,3例可见蛋白-细胞分离现象。结合患者临床表现、发病特点及相关医技检查结果诊断为脑干脑炎。1例自行痊愈,余给予糖皮质激素和(或)免疫球蛋和(或)抗病毒治疗,13例明显好转,1例复发。结论脑干脑炎病因尚不明确,诊断需结合临床表现、发病特点及相关医技检查结果综合分析,动态头颅MRI检查可帮助诊断;本病予糖皮质激素、丙种球蛋白及抗病毒药物治疗有效,大多预后良好。     

以动眼神经麻痹首发的老年糖尿病12例临床分析

目的探讨以动眼神经麻痹首发的老年糖尿病特点及延误诊断原因。方法对近8年来12例以动眼神经麻痹首发的老年糖尿病进行分析。结果12例全部以单侧眼睑下垂或不能完全睁眼为首发表现,伴复视2例,头痛10例,瞳孔轻度扩大1例,右侧眼7例,左侧眼5例。眼底检查:表现眼底动脉细8例,不同动静脉交叉压迹3例。首诊误诊8例,最长延误达14d。结论以动眼神经麻痹首发的老年糖尿病较少见,易漏误诊,预后好。     

先天性支气管闭锁误诊为肺内型支气管囊肿一例并文献分析

目的探讨先天性支气管闭锁(congenital bronchial atresia,CBA)的临床表现、影像学特点及治疗原则,以提高该病的诊疗水平。方法回顾性分析我院CBA误诊为肺内型支气管囊肿1例的临床资料,并复习相关文献。结果本例因反复肺部感染就诊,曾误诊为支气管囊肿伴感染,经胸部CT扫描确诊为CBA。患者拒绝手术,目前随访观察中,病情稳定。结论 CBA多无明显症状,需完善相关检查排除肺内型支气管囊肿、支气管肿瘤等引起支气管阻塞性疾病可能,以提高临床确诊率。     

Transient vocal cord paralysis following central venous hemodialysis catheter insertion

In this article, we present a case of recurrent laryngeal nerve palsy not caused by nerve injury but due to local anesthetic infiltration that was applied prior to central venous catheterization. A 47-year-old female patient was admitted to emergency room with fatigue and nausea and was diagnosed with acute renal failure. Right jugular venous catheterization was performed for emergency hemodialysis with Seldinger technique using middle approach. Within minutes and immediately after the procedure the patient complained of hoarseness and shortness of breath, and she had stridor in her physical exam. Awake flexible fibreoptic laryngoscopy revealed unilateral right-sided vocal cord paralysis with no edema. The patient was asked to remain nil per os and observed in ER with nasal oxygen. At the 3rd hour of follow-up without any other intervention, her symptoms resolved. Due to its proximity to the internal jugular vein injury to the recurrent laryngeal nerve while attempting to insert a central venous line can occur, particularly with difficult and repeated attempts. Local anesthesia led temporary ipsilateral vocal cord paralysis in patients undergoing carotid endarterectomy is described in literature. We think temporary vocal cord palsy in our case was due to local anesthetic infiltration rather than nerve injury, since it resolved spontaneously within only hours. Expectant treatment is a good choice ensuring the patient's airway is safe. Emergency physicians should be aware of this rare complication and its right management.     

脱细胞真皮基质黏膜补片填充治疗单侧声带麻痹

背景:脱细胞真皮基质黏膜补片作为一种新型的组织填充修复材料,具有良好的生物和结构相容性.目的:观察脱细胞真皮基质黏膜组织补片作为填充材料应用于声带内移的近远期疗效.方法:选择2009-01/2010-01 解放军第三军医大学大坪医院野战外科研究所耳鼻咽喉-头颈外科收治的单侧声带麻痹患者20 例,局麻下患侧甲状软骨板开窗,观察脱细胞真皮基质黏膜补片患侧声带下填充对改善声嘶等症状的疗效,术后1 d、3,6,12 个月各随访1 次,通过纤维喉镜观察发音时声门闭合情况,嗓音分析评估音质,包括标准化噪声能量和最长声时.结果与结论:经患者主观评价及治疗前后各阶段嗓音声学参数分析(标准化噪声能量,最长声时),证实手术近远期疗效满意,无特殊手术风险及不良反应.提示脱细胞真皮基质黏膜补片具有良好的组织相容性和易操作性,可作为声带麻痹手术治疗中声带内移的新型填充材料,临床应用疗效满意.     

CXC chemokine ligand 16 as a prognostic marker in patients with intermediate coronary artery lesions: a 2-year follow-up study

Creutzfeldt-Jakob disease (CJD) is a progressive disease that is characterized by the accumulation of abnormal prion-like proteins in the central nervous system. The cerebral cortex is primarily affected in CJD, leading to spongiform changes and dementia. To date, there have been no reported cases of CJD, with local neuroparalysis discovered at an early stage of the disease. Here, we describe a patient who presented unilateral vocal cord and soft palate paralysis before the progression of CJD. After developing forgetfulness 6 months ago, a 76-year-old woman was presented at department of Otorhinolaryngology in a general hospital for recently developed hoarseness and dysphagia. In the oral and laryngeal endoscopic findings, unilateral paralysis of the vocal cord and soft palate was noted. On videofluorography, the larynx failed to elevate straight on swallowing. The right tongue pharyngeal wall was lax, and some contrast agent was retained in the lower right piriform sinus. The paralysis was thought to be due to the glossopharyngeal nerve or vagal nerve damage, which was caused by peripheral nerve injury or infranuclear palsy. Diffusion-weighted magnetic resonance imaging (MRI) revealed high signals in the cerebral cortical area (a signature feature of CJD). The patient died 2.5 years after the onset of illness. The patient was diagnosed as probable sporadic CJD. Since we could not detect any peripheral organic findings that could cause the paralysis, we suspect that CJD is responsible for the paralysis. In treating CJD patients with neurological signs, exclusive investigation is required to obtain a more detailed picture of the disease.     

Unilateral vocal cord palsy in a diabetic patient

Remittent isolated palsy of peripheral or of upper cranial nerves in patients with diabetes mellitus is well documented, but paralysis of a lower cranial nerve or an isolated branch of any cranial nerve has not been previously reported. In the case described, temporary paralysis of the left recurrent laryngeal nerve caused vocal cord palsy in a patient with insulin-dependent diabetes. The patient had hoarseness, which totally remitted within eight weeks, presumably owing to improved metabolic control.     

脱细胞真皮基质黏膜补片填充治疗单侧声带麻痹

背景：脱细胞真皮基质黏膜补片作为一种新型的组织填充修复材料,具有良好的生物和结构相容性。目的：观察脱细胞真皮基质黏膜组织补片作为填充材料应用于声带内移的近远期疗效。方法：选择2009-01/2010-01解放军第三军医大学大坪医院野战外科研究所耳鼻咽喉-头颈外科收治的单侧声带麻痹患者20例,局麻下患侧甲状软骨板开窗,观察脱细胞真皮基质黏膜补片患侧声带下填充对改善声嘶等症状的疗效,术后1d、3,6,12个月各随访1次,通过纤维喉镜观察发音时声门闭合情况,嗓音分析评估音质,包括标准化噪声能量和最长声时。结果与结论：经患者主观评价及治疗前后各阶段嗓音声学参数分析（标准化噪声能量,最长声时）,证实手术近远期疗效满意,无特殊手术风险及不良反应。提示脱细胞真皮基质黏膜补片具有良好的组织相容性和易操作性,可作为声带麻痹手术治疗中声带内移的新型填充材料,临床应用疗效满意。     

甲状腺手术后声嘶的临床分析

目的 探讨甲状腺手术后声嘶的原因。方法 分析l363例各类甲状腺手术方法，并解剖和显露116例(174条)喉返神经的走行及其变异。结果 l363例中仅有12例在术后发生声嘶，发生率0．88％(12／1363)，其中l0例于1年内恢复，永久性声带麻痹者仅2例。结论 良好的手术野显露便于手术的进行，可减少术中可能导致喉返神经损伤的盲目钳夹与结扎或缝扎。喉返神经的解剖与显露在甲状腺手术中可有效地避免其损伤。     

Nonrecurrent inferior laryngeal nerve without vascular anomaly as a genuine entity

Inferior laryngeal nerve (ILN), which usually arises from vagus nerve, runs recurrent course and is called recurrent ILN (RILN). Intimate knowledge of normal and anatomic variants of the ILN reduces the risk of nerve injury and vocal cord paralysis in thyroid and parathyroid surgery. The nonrecurrent ILN (NRILN) is a rare nerve anomaly that is associated with a right aberrant subclavian artery. We encountered 2 patients with NRILN during thyroid surgery. Patient 1, a 57-year-old woman, had mediastinal thyroid tumor without vascular anomaly. Patient 2, a 47-year-old woman with a history of esophageal foreign body (fish bone), was suspected to have NRILN with vascular anomaly before surgery, as judged by preoperative enhanced CT. In the patient 1, we verified laryngeal mobility function of the NRILN by nerve stimulation, and confirmed the absence of RILN in usual recurrent course. The findings in the patient 1 indicate that NRILN without subclavian artery anomaly is a genuine entity. In both patients we performed thyroid surgery safely and fast by expectation and identification of NRILN by use of nerve stimulator. In conclusion, we confirm the existence of NRILN without vascular anomaly and show effectiveness of preoperative enhanced CT and valuable use of nerve stimulator for nerve preservation in the patients with NRILN.     

15例声带麻痹患儿先天性心脏病术后护理

目的:探讨声带麻痹患儿先天性心脏病术后的护理措施。方法:做好插管时期的护理、病情观察及呼吸道的护理,减少患儿在插管过程中的躁动行为,防止损伤喉返神经及预防肺动脉高压危象的发生。撤除呼吸机的配合及撤机后的护理,观察患儿的发音情况,有无声嘶、呼吸困难,掌握正确的喂养方法,防止误吸。结果:15例患儿均恢复良好,转至普通病房继续治疗,最后均顺利出院。结论:针对性的临床护理对改善声带麻痹患儿先天性心脏病术后的预后有着重要的作用。