대한두경부종양학회지 (Korean Journal of Head & Neck Oncology)

  • 제30권2호
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  • Pages.74-78
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  • 2014
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  • 1229-5183(pISSN)
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  • 2586-2553(eISSN)
대한두경부종양학회 (The Korean Society for Head and Neck Oncology)
권호 표지

갑상선 수술 후 발생한 편측 횡격막 마비 1예

Unilateral Diaphragmatic Paralysis after Thyroid Surgery

  • 변종규 (경희대학교 의과대학 내분비대사내과학교실) ;
  • 이상열 (경희대학교 의과대학 내분비대사내과학교실) ;
  • 김유진 (경희대학교 의과대학 내분비대사내과학교실) ;
  • 엄유진 (경희대학교 의과대학 내분비대사내과학교실) ;
  • 김슬기 (경희대학교 의과대학 내분비대사내과학교실) ;
  • 손정일 (경희대학교 의과대학 내분비대사내과학교실) ;
  • 진상욱 (경희대학교 의과대학 내분비대사내과학교실) ;
  • 전숙 (경희대학교 의과대학 내분비대사내과학교실) ;
  • 김우식 (경희대학교 의과대학 심장내과학교실) ;
  • 김주영 (동수원병원 내과) ;
  • 이병욱 (동수원병원 내과) ;
  • 우정택 (경희대학교 의과대학 내분비대사내과학교실) ;
  • 김영설 (경희대학교 의과대학 내분비대사내과학교실)
  • Byun, Jong Kyu (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Rhee, Sang Youl (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Kim, Yu Jin (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Um, Yu Jin (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Kim, Seul Ki (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Son, Jung Il (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Chin, Sang Ouk (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Chon, Suk (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Kim, Woo-Shik (Department of Cardiology, Kyung Hee University School of Medicine) ;
  • Kim, Joo Young (Department of Internal Medicine, Dongsuwon General Hospital) ;
  • Lee, Byoung Wook (Department of Internal Medicine, Dongsuwon General Hospital) ;
  • Woo, Jeong-Taek (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Kim, Young Seol (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine)
  • 투고 : 2014.07.31
  • 심사 : 2014.09.15
  • 발행 : 2014.10.31
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초록

갑상선 암 진단과 치료기술이 발전하면서 최근 그 수술 건 수가 급격하게 증가하고 있다. 하지만이와 관련된 합병증과 부작용을 면밀하게 평가해야 할 필요 역시 점차 늘어나고 있다. 갑상선 암 수술 후 발생할 수 있는 드문 합병증의 하나로 횡격막 신경마비(phrenic nerve paralysis)가 있다. 이러한 횡격막신경마비는 대부분 증상이 경미하고 쉽게 호전되어 임상적으로 크게 중요하게 다루어지지 않았다. 하지만, 갑상선 수술 후 갑작스런 호흡곤란이 발생한다면 횡격막 신경마비에 의한 횡격막 마비(diaphragmatic paralysis)와 관련되었을 가능성을 놓치지 말아야 한다. 저자들은 최근 갑상선암 수술 후 발생한 호흡곤란으로 2년 동안 심각한 호흡곤란을 호소하던 73세 여자환자에서 투시촬영(fluoroscopy) 상 편측으로 상승되고 운동성이 저하된 횡격막을 확인하여 일측성 횡격막신경마비(Unilateral phrenic nerve paralysis)를 확진 하였다. 갑상선수술 후 발생하는 일측 횡경막 신경마비는 임상에서 드물게 관찰되는 수술 합병증이기에 환자는 상당기간 이에 대한 감별이 제대로 이루어지지 않았다. 우리는 횡격막 마비의 조기 진단과 적극적인 치료를 통하여 심한 호흡곤란을 호소하는 환자의 증상 및 병의 경과를 호전 시킬 수 있었다.

키워드

참고문헌

  1. Kweon SS, Shin MH, Chung IJ, Kim YJ, Choi JS. Thyroid cancer is the most common cancer in women, based on the data from population-based cancer registries, South Korea. Jpn J Clin Oncol. 2013;43:1039-1046. https://doi.org/10.1093/jjco/hyt102
  2. Roher HD, Goretzki PE, Hellmann P, Witte J. [Complications in thyroid surgery. Incidence and therapy]. Chirurg. 1999;70:999-1010. https://doi.org/10.1007/s001040050757
  3. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004;28:271-276. https://doi.org/10.1007/s00268-003-6903-1
  4. Pan YF, Zhang XH, Ye GH, Lin BR, Chen XM, Jia XJ, et al. [One stage thyroidectomy and bilateral neck dissection for well-differentiated thyroid carcinoma]. Zhonghua Zhong Liu Za Zhi. 2006;28:389-392.
  5. Fell SC. Surgical anatomy of the diaphragm and the phrenic nerve. Chest Surg Clin N Am. 1998;8:281-294.
  6. Mier-Jedrzejowicz A, Brophy C, Moxham J, Green M. Assessment of diaphragm weakness. Am Rev Respir Dis. 1988;137:877-883. https://doi.org/10.1164/ajrccm/137.4.877
  7. McCaul JA, Hislop WS. Transient hemi-diaphragmatic paralysis following neck surgery: report of a case and review of the literature. J R Coll Surg Edinb. 2001;46:186-188.
  8. Salati M, Cardillo G, Carbone L, Rea F, Marulli G, Brunelli A, et al. Iatrogenic phrenic nerve injury during thymectomy: the extent of the problem. J Thorac Cardiovasc Surg. 2010;139:e77-e78 https://doi.org/10.1016/j.jtcvs.2008.06.051
  9. Spear SA, Theler J, Sorensen DM. Complications after the surgical treatment of malignant thyroid disease. Mil Med. 2008;173:399-402 https://doi.org/10.7205/MILMED.173.4.399
  10. Rosato L, Nasi PG, Porcellana V, Varvello G, Mondini G, Bertone P. Unilateral phrenic nerve paralysis: a rare complication after total thyroidectomy for a large cervico-mediastinal goitre. G Chir. 2007;28:149-152.
  11. Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see commetns]. Cancer. 1998;83:2638-2648. https://doi.org/10.1002/(SICI)1097-0142(19981215)83:12<2638::AID-CNCR31>3.0.CO;2-1
  12. van Doorn LG, Kranendonk SE. Partial unilateral phrenic nerve paralysis caused by a large intrathoracic goitre. Neth J Med. 1996;48:216-219. https://doi.org/10.1016/0300-2977(95)00083-6
  13. Sayama J, Shineha R, Hirayama K, Nishihira T, Mori S. [Four cases of phrenic nerve paralysis following surgery of thoracic esophageal carcinoma]. Nihon Kyobu Geka Gakkai Zasshi. 1994;42:562-567.
  14. de Jong AA, Manni JJ. Phrenic nerve paralysis following neck dissection. Eur Arch Otorhinolaryngol. 1991;248:132-134. https://doi.org/10.1007/BF00178921
  15. Zhang S, Wang L, Li S. [Surgery for mass at root of the neck--with 26 cases report]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2011;25:529-530.
  16. Matsui Y, Hiraki T, Gobara H, Uka M, Masaoka Y, Tada A, et al. Phrenic nerve injury after radiofrequency ablation of lung tumors: retrospective evaluation of the incidence and risk factors. J Vasc Interv Radiol. 2012;23:780-785. https://doi.org/10.1016/j.jvir.2012.02.014
  17. Castresana MR, Masters RD, Castresana EJ, Stefansson S, Shaker IJ, Newman WH. Incidence and clinical significance of hemidiaphragmatic paresis in patients undergoing carotid endarterectomy during cervical plexus block anesthesia. J Neurosurg Anesthesiol. 1994;6:21-23. https://doi.org/10.1097/00008506-199401000-00003
  18. Yaddanapudi S, Shah SC. Bilateral phrenic nerve injury after neck dissection: an uncommon cause of respiratory failure. J Laryngol Otol. 1996;110:281-283.
  19. Ben-Dov I, Kaminski N, Reichert N, Rosenman J, Shulimzon T. Diaphragmatic paralysis: a clinical imitator of cardiorespiratory diseases. Isr Med Assoc J. 2008;10:579-583.
  20. Celik S, Celik M, Aydemir B, Tunckaya C, Okay T, Dogusoy I. Long-term results of diaphragmatic plication in adults with unilateral diaphragm paralysis. J Cardiothorac Surg. 2010;5:111. https://doi.org/10.1186/1749-8090-5-111
  21. Ostrowska M, de Carvalho M. Prognosis of phrenic nerve injury following thoracic interventions: four new cases and a review. Clin Neurol Neurosurg. 2012;114:199-204. https://doi.org/10.1016/j.clineuro.2011.12.016