一位喉癌患者之放射治療後雙側聲帶麻痺

Bilateral Vocal Palsy Following Radiotherapy in A Patient with Laryngeal Cancer

放射治療已是初期喉癌的標準治療方法，可能會造成喉部水腫、結構纖維化、黏膜發炎等併發症，甚至發生上呼吸消化道的狹窄或阻塞，目前並無證據證實放射治療會引起喉癌患者之聲帶麻痺。一49 歲男性，因T1aN0M0，第I 期喉癌接受強度調控放射治療，竟於放射治療停止後4 個月，因突發雙側聲帶麻痺合併呼吸道阻塞接受了氣管造口手術，術後配帶鈕扣型矽膠氣切管，爾後3 年，雙側聲帶麻痺依舊。本個案之雙側聲帶麻痺與放射治療間的因果關係不明，尚須繼續追蹤以排除癌症復發或轉移，並設法找出確切的病因，建議維持氣管造口以避免呼吸困難，暫不考慮任何整聲手術。

Radiotherapy is the gold standard treatment for early stage laryngeal cancer, but it can lead to laryngeal edema, framework fibrosis, mucositis...etc, and even stenosis or obstruction of the upper aero-digestive tract. There is limited information in the literature on whether radiotherapy leads to vocal palsy in patients with laryngeal cancer. A 49-year-old man received intensity modulated radiotherapy due to T1aN0M0, stage I laryngeal cancer. However, four months after the radiotherapy was complete, bilateral vocal palsy with acute airway obstruction occurred. He received tracheostomy, which was then retained by a silicon stoma stent. In the following three years, the bilateral vocal palsy was remained. The causation between the following bilateral vocal palsy and the antecedent radiotherapy is unknown. Cancer recurrence or metastasis, or others are the possible etiologies. The tracheostomy stoma should be retained to prevent dyspnea. Any kind of phonoplasty surgery is not recommended at present.