甲状腺癌颈部淋巴结清扫术后双侧乳糜胸2例并文献复习  

Bilateral chylothorax after neck dissection for thyroid cancer: a report of 2 cases and literature review

作　　者：冯铁诚 李新营[1] 李劲东[1] 张哲嘉[1] 彭瑶[1] 王文龙[1] 

机构地区：[1]中南大学湘雅医院普通外科甲状腺专科,湖南长沙410008

出　　处：《中国普通外科杂志》2017年第5期573-577,共5页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81372860)

摘　　要：目的:探讨甲状腺癌颈部淋巴结清扫术后双侧乳糜胸的诊断及治疗。方法:回顾性分析2例甲状腺癌颈部淋巴结清扫术后出现的双侧乳糜胸患者的临床资料,并复习相关文献。结果:2例患者均因甲状腺乳头状癌行颈部淋巴结清扫术,术中均未发现淋巴液渗漏。均于术后第4天出现气促、呼吸困难,经胸部X线检查为双侧胸腔积液,行双侧胸腔闭式引流出乳白色乳糜液,证实为双侧乳糜胸。2例患者经禁食、奥曲肽等积极治疗后,引流量逐渐减少,复查胸部X线胸部无积液后拔除引流管。结论:双侧乳糜胸是甲状腺癌颈淋巴结清扫术后罕见的并发症,早期发现后给予积极的保守治疗是安全有效的。Objective： To investigate the diagnosis and treatment of bilateral chylothorax following neck dissection for thyroid cancer. Methods： The clinical data of two patients with bilateral chylothorax after neck dissection for thyroid cancer were retrospectively analyzed, and combined with related literature review. Results： Both patients underwent neck dissection for papillary thyroid carcinoma and no lymphorrhea was observed in either of them during operation. On the fourth postoperative day~ both patients developed shortness of breath and dyspnea, and were found to have bilateral hydrothorax by chest X-ray examination and milky chylous fluid was drained with bilateral dosed drainage ofpleural cavil, and then were diagnosed as bilateral chylothorax. After aggressive treatment such as fasting and octreotide administration, the drainage volumes of the two patients were gradually reduced, and their drainage tubes were removed after thoracic fluid collections disappeared in review X-ray examination.Conclusion＂ Bilateral chylothorax is an extremely rare complication after neck dissection for thyroid cancer, and aggressive conservative treatment is safe and effective after early detection.

关 键 词：甲状腺肿瘤 颈淋巴结清扫术 乳糜胸 

分 类 号：R736.1[医药卫生—肿瘤]