甲状腺癌颈清扫术后乳糜漏的综合治疗  

Combined treatment of chylous leakage after lymph node dissection for thyroid cancer

作　　者：房忠菊 张永侠 赵建东[2] 纵亮[2] 翟性友 李新建[3] 彭新 任楠 陈立伟[2] 刘明波[2,3] FANG Zhongju;ZHANG Yongxia;ZHAO Jiandong;ZONG Liang;ZHAI Xingyou;LI Xinjian;PENG Xin;REN Nan;CHEN Liwei;LIU Mingbo(Department of ENT,Weifang Medical University,Weifang 261053,Shandong,China;Department of Otolaryngology-Head and Neck Surgery,Institute of Otolaryngology,Chinese PLA General Hospital/National Clinical Research Center for Otolaryngologic Diseases,Beijing 100853,China;Department of Otolaryngology Head and Neck Surgery,Hainan Hospital of Chinese PLA General Hospital/The Clinical Medical Research Center for Otolaryngology Head and Neck Surgery of Hainan Provincial,Sanya 572013,Hainan,China)

机构地区：[1]潍坊医学院研究生院耳鼻喉教研室,山东潍坊261053 [2]中国人民解放军总医院耳鼻咽喉头颈外科医学部/国家耳鼻咽喉疾病临床医学研究中心,北京100853 [3]解放军总医院海南医院耳鼻喉头颈外科/海南省耳鼻咽喉头颈疾病临床医学研究中心,海南三亚572013

出　　处：《山东大学耳鼻喉眼学报》2020年第3期64-68,共5页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：海南省重点研发计划项目(ZDYF2017076)。

摘　　要：目的探讨甲状腺癌颈淋巴清扫术后产生乳糜漏的原因及处理策略。方法回顾性分析647例甲状腺乳头状癌患者行颈淋巴清扫术后的临床资料。对11例术后发生乳糜漏的患者给予静脉营养、低脂饮食、局部加压及负压引流等措施。结果该组患者乳糜漏出现在手术后的第0.5~3.0天,其发生率为1.7%,患者乳糜漏的峰值引流量为120~1100 mL/d。该组患者接受淋巴结清扫区域:单侧叶+峡部切除449例,接受全甲状腺切除152例,单侧叶+峡部切除+对侧次全切除46例;单纯中央区淋巴结清扫总共395例,发生乳糜漏5例,发生率为1.26%(5/395)。侧颈+中央区淋巴清扫共83例,发生乳糜漏4例,发生率为4.8%(4/83),内镜辅助上纵隔清扫总共6例,发生乳糜漏2例,发生率为33.3%(2/6)。乳糜漏左侧与右侧之比为7∶4;其中3例患者为复发再清扫(rRLN)。每日引流量<20 mL/d时拔管,乳糜漏闭合时间为6~23 d,中位时间11 d。所有患者未行二次手术处理。结论甲状腺癌行淋巴结清扫手术时应仔细规范操作以预防乳糜漏的发生,及时采取调整饮食、负压引流等综合措施多可治愈,保守治疗无效时行手术治疗。Objective To explore the causes and treatment of chyle leakage after lymph node dissection(LND)for thyroid carcinoma.Methods A retrospective analysis was conducted in 647 patients who underwent LND for thyroid carcinoma.For the 11 patients who developed chyle leakage,measures such as intravenous nutrition,low-fat diet,local compression and negative pressure drainage were taken.Results Chylous leakage occurred on day 0.5 to 3 after surgery,and the incidence was 1.7%.The peak drainage of chylous leakage was 120 to 1100 mL/d.Unilateral lobectomy+isthmectomy was performed in 449 cases,total thyroidectomy in 152 cases,and unilateral lobectomy+isthmectomy+contralateral subtotal thyroidectomy in 46 cases.Simple central lymph node dissection was performed in 395 cases,5 of whom developed chyle leakage,and the incidence was 1.26%(5/395).Lateral neck+central lymphatic dissection was performed in 83 cases,4 of whom developed chyle leakage,and the incidence was 4.8%(4/83).Upper mediastinal dissection with endoscope was performed in 6 cases,2 of whom developed chyle leakage,and the incidence was 33.3%(2/6).The ratio of left to right chylous leakage was 7:4.Three patients had relapse dissection(rRLN).When the daily drainage volume was less than 20 mL/d,the drainage tube was removed.The closing time of chylous leakage was 6 to 23 days,median 11 days.No second operation was performed.Conclusion When lymph node dissection for thyroid carcinoma is performed,the procedures should be standardized to prevent chylous leakage.In case chylous leakage occurs,measures such as diet adjustment and negative pressure drainage can help the cure.Surgery must be performed when the conservative treatment is ineffective.

关 键 词：甲状腺癌 术后并发症 乳糜漏 颈淋巴结清扫术 

分 类 号：R736.1[医药卫生—肿瘤]