中国实用外科杂志

中国实用外科杂志

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甲状腺癌中央区淋巴结清扫术后并发乳糜漏14例临床分析

董凌翔，贺    亮，张    浩，张    平，董文武，王志宏，张大林，吕承洲   

  1. 中国医科大学附属第一医院甲状腺外科，辽宁沈阳110001
  • 出版日期:2019-02-01 发布日期:2019-01-31

  • Online:2019-02-01 Published:2019-01-31

摘要：

目的    探讨甲状腺癌中央区淋巴结清扫术后并发乳糜漏的原因、临床特点和诊治方法。方法    回顾性分析2011年12月至2017年2月在中国医科大学附属第一医院甲状腺外科行甲状腺癌中央区淋巴结清扫术病人中14例术后发生乳糜漏病例的临床资料。结果    乳糜漏发生率为0.5%，出现在术后的第1～2 天，中位时间1.5 d；发生乳糜漏之前的引流量峰值为30～76 mL，中位数为49 mL；乳糜漏发生后，引流量进一步增多，最大值为30～135 mL，中位数为57.5 mL。乳糜漏病人淋巴结清扫区域：左侧中央区清扫3例（21.4%）；右侧中央区清扫8例（57.2%），其中4例包含右侧喉返神经（rRLN）深面(rⅥb区)淋巴结清扫；双侧中央区清扫3例（21.4%，均不包含rⅥb区清扫）。淋巴结清扫数目0～14枚。发生乳糜漏后，2例经低脂饮食痊愈，7例经禁食水痊愈，剩余5例调整饮食效果不佳，辅以持续低负压吸引后痊愈。乳糜漏基本治愈时间为1～8 d, 中位时间3 d。结论    甲状腺癌中央区淋巴结清扫术后乳糜漏发生率较低，引流量一般较少，术后1～2天引流量异常增多及性质改变时应警惕乳糜漏的发生，及时采取调整饮食或辅以持续负压吸引可在短期内治愈。

关键词: 甲状腺癌, 中央区淋巴结清扫术, 乳糜漏

Abstract:

Chylous leakage after thyroid cancer surgery with central lymph node dissection: A clinical analysis of 14 cases          DONG Ling-xiang, HE Liang, ZHANG Hao, et al. Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang 110001, China
Corresponding author: ZHANG Hao, E-mail：haozhang@cmu.edu.cn
Abstract    Objective    To explore the pathogeny, the clinical characteristics, diagnosis and treatment of chylous leakage after thyroid cancer surgery with central lymph node dissection (CLND). Methods    The clinical data of 14 cases of chylous leakage after thyroid cancer surgery with CLND admitted in the Department of Thyroid Surgery, the First Hospital of China Medical University between December 2011 and February 2017 were analyzed retrospectively. Results    The incidence of chylous leakage was 0.5%. It occurred in the median of postoperative 1.5 days (range 1 to 2). The median volume of peak drainage before chylous leakage was 49 mL (range 30 to 76). When it happened, the volume increased. The median volume of the maximum drainage after surgery was 57.5 mL (range 30 to 135). Chylous fistula occurred after left CLND in 3 cases (21.4%). Right CLND in 8 cases (57.2%), in which 4 cases had rⅥb lymph node dissection. Bilateral CLND in 3 cases (21.4%, which did not have rⅥb lymph node dissection). The number of dissected lymph node were 0 to 14. After chylous leakage happened, 2 cases were cured by low fat diet and 7 cases were cured by water fasting. The remaining 5 cases had poor effect of adjusting diet. They recovered with continuous low negative pressure drainage. The median healing time was 3 days (range 1 to 8). Conclusion    The incidence of chylous leakage after thyroid cancer surgery with CLND is low. Chylous leakage should be watch out after CLND, when drainage increases abnormally or the liquid property change. It can be treated by diet adjustment and continuous suction in a very short time.

Key words: thyroid cancer, central lymph node dissection, chylous leakage