经口入路腔镜甲状腺癌侧颈淋巴结清扫手术后淋巴漏的防治:附47例报道  

Prevention and treatment of lymphatic leak following transoral endoscopic thyroid cancer lateral neck lymph node dissection:a report of 47 cases

作　　者：李武 李慧 周诗韦 伍鹏 宋小花 王青霞 李文凯 彭小伟 LI Wu;LI Hui;ZHOU Shiwei;WU Peng;SONG Xiaohua;WANG Qingxia;LI Wenkai;PENG Xiaowei(Department of Thyroid Surgery,Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410007,P.R.China)

机构地区：[1]湖南省肿瘤医院/中南大学湘雅医学院附属肿瘤医院甲状腺外科,长沙410007

出　　处：《中国普外基础与临床杂志》2024年第11期1324-1329,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：湖南省肿瘤医院科研攀登计划国自培育项目(项目编号:2020NSFC-B007);湖南省肿瘤医院科研攀登计划2020年度重大专项(项目编号:ZX2020002-5);2024年度湖南省自然科学基金项目(项目编号:2024JJ9251);2024年度创新型省份建设专项科普专题项目(项目编号:2024ZK4141)。

摘　　要：目的总结经口入路腔镜甲状腺癌侧颈淋巴结清扫手术后淋巴漏的防治策略及效果。方法回顾性收集2021年1月至2023年5月期间于笔者所在医院行经口入路腔镜甲状腺切除及侧颈淋巴结清扫术的47例甲状腺乳头状癌患者的临床资料。对于术后出现淋巴漏的患者,采取递进式的序贯治疗方案:低脂低蛋白饮食、持续强负压吸引、a群链球菌皮下术腔注射以及小切口胸导管或淋巴管结扎,总结序贯治疗方案的效果。结果47例患者术后有5例患者发生淋巴漏。1号患者先后通过肩胛舌骨肌瓣填塞静脉角、低脂低蛋白饮食、术后持续强负压吸引、a群链球菌术腔注射,最后小切口胸导管或者淋巴管结扎治愈淋巴漏。20号患者初次术中以肩胛舌骨肌瓣填塞静脉角,而后采用低脂低蛋白饮食、术后持续强负压吸引以及a群链球菌术腔注射,保守治愈了淋巴漏。28号患者通过肩胛舌骨肌瓣填塞静脉角、低脂低蛋白饮食和术后持续强负压吸引即康复。30号患者的处理过程同1号患者,36号患者的处理过程同20号患者。通过递进式的序贯治疗措施,5例患者均成功治愈淋巴漏;术后住院时间3~17 d,平均8.6 d。结论本研究采用的递进式序贯治疗方案可以有效治疗经口入路甲状腺癌侧颈淋巴结清扫术后的淋巴漏。鉴于本研究的样本量较少,有必要进行长期研究来确认这些措施的持久性和稳定性。Objective To summarize the prevention and treatment strategies and their effects on lymphatic leakage following transoral endoscopic thyroid cancer lateral neck lymph node dissection.Methods A retrospective review was conducted,we collected clinical data from 47 patients with papillary thyroid carcinoma who underwent transoral endoscopic thyroidectomy and lateral neck lymph node dissection at our hospital from January 2021 to May 2023.A stepwise sequential treatment plan was adopted for patients with postoperative lymphatic leakage:low-fat,lowprotein diet,continuous strong negative pressure suction,subcutaneous injection of Group A streptococcus in the surgical cavity,and ligation of the thoracic duct or lymphatic vessels through a small incision.The effectiveness of the sequential treatment plan was summarized.Results Out of the 47 patients,lymphatic leakage occurred in 5 cases postoperatively.Patient No.1 was cured of lymphatic leakage after sequential treatments including pectoralis major muscle flap occlusion of the jugular venous angle,low-fat,low-protein diet,continuous strong negative pressure suction postoperatively,subcutaneous injection of Group A streptococcus in the surgical cavity,and finally ligation of the thoracic duct or lymphatic vessels through a small incision.Patient No.20 was conservatively cured of lymphatic leakage with an initial surgical procedure involving pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet,continuous strong negative pressure suction postoperatively, and subcutaneous injection of Group A streptococcus in thesurgical cavity. Patient No.28 recovered after only pectoralis major muscle flap occlusion of the jugular venous angle, lowfat,low-protein diet and continuous strong negative pressure suction postoperatively. Treatment process of patient No.30was the same as Patient No.1, Patient No.36 was the same as Patient No.20. Through the stepwise sequential treatmentmeasures, all 5 patients successfully recovered from lymphatic leakage

关 键 词：淋巴漏 腔镜手术 侧颈淋巴结清扫 甲状腺乳头状癌 防治措施 

分 类 号：R736.1[医药卫生—肿瘤]