Frequent occurrence of postbreakfast syncope due to carotid sinus syndrome after surgery for hypopharyngeal cancer: A case report.
Frequent occurrence of postbreakfast syncope due to carotid sinus syndrome after surgery for hypopharyngeal cancer: A case report.
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下咽癌术后颈动脉窦综合征致早餐后频繁晕厥1例。
DOI：
10.1097/md.0000000000025959
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发表时间：
2021-05-21
期刊：
影响因子：
1.6
通讯作者：
Tanaka Y
中科院分区：
文献类型：
--
作者：
Ando Y;Hashimoto K;Sano A;Fujita N;Yanagawa R;Ono Y;Obuchi Y;Tatsushima D;Watanabe S;Tomifuji M;Tanaka Y
由于肿瘤刺激自主神经系统，晚期头颈癌患者常发生晕厥。在这里，我们描述一个病例频繁晕厥发作后喉咽癌切除术。由于所有晕厥发作均在上午观察到，我们还使用动态心电图评估了心率变异性，以确定晕厥发作发生在一天中特定时间段的原因。一名73岁的日本男性因复发性下咽癌接受了喉咽切除术，在同一时间段（10：00-12：00）开始频繁发生意识丧失。手术前他从未出现过晕厥发作。从术后23天到41天，他经历了9次晕厥发作，无论他的姿势如何。 咽食管镜检查显示游离空肠移植物和食管上段之间的吻合口狭窄。吞咽视频荧光透视证实了空肠自体移植物的扩张和异物卡在吻合口侧。对比增强计算机断层扫描显示，颈动脉轻度压迫水肿的游离空肠。患者被诊断为颈动脉窦综合征（CSS），因为进食早餐时游离空肠扩张，这可能导致颈动脉窦超敏反应并诱导延髓反射。丙吡胺能有效预防晕厥。动态心电图心率变异性分析显示，在10：00至12：00期间，副交感神经优势转变为交感神经优势。晕厥发作的显著时间规律性可能受到自主神经张力活动的昼夜变化的影响。经开颈入路手术松解并重新吻合咽食管狭窄后，未报告晕厥复发。我们报告一例下咽癌手术后因CSS而于上午发生频繁晕厥的病例。患者接受了抗胆碱能药物治疗，随后进行了咽食管狭窄的松解和重新吻合。当头颈部病变手术后发生晕厥时，由于术后结构变化引起的CSS应被视为晕厥的鉴别诊断。
Syncope often occurs in patients with advanced head and neck cancers due to the stimulation of the autonomic nervous system by the tumor. Here, we describe a case of frequent syncopal episodes after laryngopharyngectomy for hypopharyngeal cancer. As all syncopal episodes were observed during the forenoon, we also evaluated the heart rate variability using ambulatory electrocardiography to determine why the syncopal episodes occurred during a specified period of the day. A 73-year-old Japanese man who underwent laryngopharyngectomy for recurrent hypopharyngeal cancer started experiencing frequent episodes of loss of consciousness that occurred during the same time period (10:00–12:00). He had never experienced syncopal episodes before the operation. From 23 to 41 days postoperatively, he experienced 9 syncopal episodes that occurred regardless of his posture. Pharyngo-esophagoscopy revealed an anastomotic stricture between the free jejunum graft and the upper esophagus. Swallowing videofluoroscopy confirmed the dilatation of the jejunal autograft and a foreign body stuck on the oral side of the anastomosis. Contrast-enhanced computed tomography revealed that the carotid artery was slightly compressed by the edematous free jejunum. The patient was diagnosed with carotid sinus syndrome (CSS) as the free jejunum was dilated when consuming breakfast, which may have caused carotid sinus hypersensitivity and induced a medullary reflex. Administration of disopyramide was effective in preventing syncope. Heart rate variability analysis using ambulatory electrocardiography showed that parasympathetic dominancy shifted to sympathetic dominancy during 10:00 to 12:00. The significant time regularity of the syncopal episodes may have been affected by modified diurnal variation in autonomic tone activity. After the surgical release and re-anastomosis of the pharyngoesophageal stenosis via an open-neck approach, no recurrent episodes of syncope were reported. We reported a case of frequent syncopal episodes limited to the forenoon due to CSS after surgery for hypopharyngeal carcinoma. The patient was treated with anticholinergics followed by the release and re-anastomosis of the pharyngoesophageal stenosis. When syncope occurs after surgery for head and neck lesions, CSS due to postoperative structural changes should be considered as a differential diagnosis of syncope.