胸导管显微修补术及结扎术在甲状腺癌术中处理胸导管损伤的临床疗效分析  

Application and efficacy of thoracic duct suture repair and ligation techniques in the treatment of chyle leak after neck dissection

作　　者：袁芊芊 李承欣 邢明照 田瑶 田文 吴高松 Yuan Qianqian;Li Chengxin;Xing Mingzhao;Tian Yao;Tian Wen;Wu Gaosong(Department of Thyroid and Breast Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Southern University of Science and Technology,Shenzhen 518055,China;Department of Thyroid and Breast Surgery,Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China;Department of General Surgery,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]武汉大学中南医院甲状腺乳腺外科,武汉430071 [2]南方科技大学,深圳518055 [3]华中科技大学同济医学院附属同济医院甲状腺乳腺外科,武汉430030 [4]中国人民解放军总医院第一医学中心普通外科医学部甲状腺(疝)外科,北京100853

出　　处：《中华内分泌外科杂志》2023年第4期390-393,共4页Chinese Journal of Endocrine Surgery

基　　金：湖北省卫生计生委联合基金立项项目(WJ2015MA003、WJ2018H0014、cxpy2017068);湖北省自然科学基金委项目(2008CDB179、2012FFB02310);湖北省人社厅项目(LX1900000001)。

摘　　要：目的比较胸导管显微修补与结扎术在处理甲状腺癌术中医源性胸导管损伤,预防术后乳糜漏的有效性及安全性。方法回顾性分析2012年5月至2019年12月华中科技大学同济医学院附属同济医院和武汉大学中南医院甲状腺乳腺外科收治的2759例甲状腺癌伴颈部淋巴结转移患者的临床资料,术中胸导管破损69例,2016年6月前30例行胸导管常规结扎术(结扎组),2016年6月后39例行胸导管漏口显微修补术(修补组)。纳入年龄、性别、颈部淋巴结清扫手术方式、淋巴结清扫数、淋巴结转移数、淋巴结是否包膜外侵犯、胸导管注入静脉点及手术时间。分析患者临床资料,记录发生术后乳糜漏患者的日最高引流量、乳糜漏持续时间,应用t检验、x^(2)检验比较两组乳糜漏发生率、手术时间、住院时间等差异有无统计学意义。结果修补组年龄(43.2±9.3)岁,39例术中成功实施胸导管显微缝补术,术后未出现乳糜漏;结扎组年龄(49.5±10.0)岁,30例术中成功实施胸导管漏口结扎术,有5例(16.7%)发生乳糜漏,日最高引流量平均值为1008ml,乳糜漏持续中位时间3d。修补组的乳糜漏发生率较结扎组显著降低(0 vs16.7%,P=0.013)、住院时间显著缩短[6.1(6.0,6.5)d vs 10.0(9.0,10.0)d(Z=-7.21,P=0.014)],两组手术时间差异无统计学意义[(110.9±8.7)min vs(109.3±7.9 min)(t=0.82,P=0.421)]。结论甲状腺癌术中对破损的胸导管可行预防性显微修补术,可作为一种有效减少术后乳糜漏的预防方法。Objective To investigate the efficacy and safety of thoracic duct repair in the treatment of iat-rogenic thoracic duct injury in thyroid surgery.Methods Clinical data of 2759 cases with lymph nodes metasta-sis from papillary thyroid carcinomas at two tertiary referral academic medical centers,viz.Tongji Hospital of Hua-zhong University of Science and Technology and Zhongnan Hospital of Wuhan University were retrospectively ana-lyzed,of which 69 cases encountered injured thoracic duct.Thirty patients received thoracic duct ligation(ligation group)before Jun.2016,and thirty-nine with direct suture repair of lacerated duct(repair group).Age,sex,cervi-cal clearance surgery,lymph node dissection,lymph node metastasis,whether lymph nodes were invaded extracap-sular,chest catheter injection into venous points,and operation time were recorded.Results In the thoracic duct direct suture repair group,39 patients with a mean age of(43.2±9.3)successfully performed intraoperative thoracic duct sutures and only one patient developed CL postoperatively.In the thoracic duct ligation group,30 ducts with a mean age of(49.5±10.0)were successfully ligated during the operation,and 5(16.7%)still developed CL after operations,with the highest daily drainage volume of more than 500 ml,and the median duration of chylous leakage of 3 days.The incidence of CL in the thoracic duct direct suture repair group was significantly lower than that in the ligation group(0 vs 16.7%,P=0.013),and the length of hospital stay in the repair group was also significantly shorter(6.1(6.0,6.5)vs 10.0(9.0,10.0)day,Z=-7.21,P=0.014).There was no significant difference in operation time between the two groups(110.9±8.7 vs 109.3±7.9,t=0.82,P=0.421).Conclusion Compared with thoracic duct ligation,thoracic duct direct suture repair in patients with intraoperative thoracic duct injury may be an effective method to reduce postoperative CL.

关 键 词：甲状腺癌 胸导管 乳糜漏 胸导管损伤 

分 类 号：R736.1[医药卫生—肿瘤]