甲状腺癌颈淋巴结清扫术后难治性乳糜漏临床分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

王刚 , 于芳 , 范子义 , 王猛 , 王丹 , 周鹏 , 李小磊 , 厉彦辰 ,  贺青卿

解放军第九六〇医院甲状腺乳腺外科（济南 250031）;

Corresponding author：

贺青卿, Email: heqingqing@yeah.net

Keywords：

甲状腺癌; 乳糜漏; 颈淋巴结清扫术; 淋巴管瘘结扎术

DOI：

10.7507/1007-9424.202107107

Video：

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目的分析甲状腺癌手术后难治性乳糜漏的临床特点，探讨难治性乳糜漏的治疗策略。方法回顾性分析解放军第九六〇医院（原济南军区总医院）2009年 1 月至 2021 年1 月期间收治的 5 021例行甲状腺癌颈淋巴结清扫术患者的临床资料，术后发生乳糜漏122例，其中治疗时间超过2周的难治性乳糜漏34例，对难治性乳糜漏患者的一般情况、治疗方式、峰值引流量（日最高引流量）、带管时间等进行分析总结。结果 5 021例患者中发生乳糜漏122例，占所有患者的2.4%。经非手术治疗2周内治愈者88例，占乳糜漏总数的72.1%；治疗时间超过2周的难治性乳糜漏34例，占乳糜漏总数的27.9%。难治性乳糜漏经非手术方法治愈者18例，经再次手术治愈者16例，2组患者的乳糜漏位置左侧多于右侧；34例难治性乳糜漏峰值引流量（日最高引流量）手术组（16例）高于非手术组（P<0.05），带管时间手术组短于非手术组（P<0.05）。结论低峰值引流量乳糜漏经非手术治疗多可治愈；难治性乳糜漏左侧多见，高流量乳糜漏（峰值引流量≥1 000 mL）宜早期实施手术治疗。

Citation： 王刚, 于芳, 范子义, 王猛, 王丹, 周鹏, 李小磊, 厉彦辰, 贺青卿. 甲状腺癌颈淋巴结清扫术后难治性乳糜漏临床分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(4): 517-521. doi: 10.7507/1007-9424.202107107 Copy

1.	Park I, Her N, Choe JH, et al. Management of chyle leakage after thyroidectomy, cervical lymph node dissection, in patients with thyroid cancer. Head Neck, 2018, 40(1): 7-15.
2.	Song R, Fei X, Cui J, et al. Treatment strategy for chylous leakage after dissection of central lymph nodes in thyroid cancer. Ann Ital Chir, 2020, 91: 692-696.
3.	Chen CY, Chen YH, Shiau EL, et al. Therapeutic role of ultrasound-guided intranodal lymphangiography in refractory cervical chylous leakage after neck dissection: Report of a case and review of the literature. Head Neck, 2016, 38(2): E54-E60. doi: 10.1002/hed.24134.
4.	孙团起, 吴毅. 甲状腺手术乳糜漏发生原因及防治. 中国实用外科杂志, 2012, 32(5): 372-374.
5.	姜军, 李世超. 甲状腺癌—分化型甲状腺癌淋巴结转移特点及颈侧方淋巴结清扫术局部应用解剖. 中国实用外科杂志, 2011, 31(5): 380-383.
6.	Tenny BC, Madjarov J, Shipe T, et al. Surgical intervention in a complicated persistent chyle leak. Int J Surg Case Rep, 2018, 42: 7-9.
7.	房忠菊, 张永侠, 赵建东, 等. 甲状腺癌颈清扫术后乳糜漏的综合治疗. 山东大学耳鼻喉眼学报, 2020, 34(3): 64-68.
8.	Campisi CC, Boccardo F, Piazza C, et al. Evolution of chylous fistula management after neck dissection. Curr Opin Otolaryngol Head Neck Surg, 2013, 21(2): 150-156.
9.	Kannan RR, Mahajan V, Ayyappan S. Management of chyle fistulae following surgery in the neck. Indian J Cancer, 2001, 38(2-4): 117-120.
10.	He Q, Zhu J, Zhuang D, et al. Robotic lateral cervical lymph node dissection via bilateral axillo-breast approach for papillary thyroid carcinoma: a single-center experience of 260 cases. J Robot Surg, 2020, 14(2): 317-323.
11.	黄庆锦, 林孝文, 张再重, 等. 乳头状甲状腺癌择区性颈淋巴结清扫术后乳糜漏的比较研究. 中华普通外科学文献(电子版), 2018, 12(1): 54-56.
12.	Delaney SW, Shi H, Shokrani A, et al. Management of chyle leak after head and neck surgery: review of current treatment strategies. Int J Otolaryngol, 2017, 2017: 8362874. doi: 10.1155/2017/8362874.
13.	Stager V, Le L, Wood RE. Postoperative chylothorax successfully treated using conservative strategies. Proc (Bayl Univ Med Cent), 2010, 23(2): 134-138.
14.	Maldonado F, Hawkins FJ, Daniels CE, et al. Pleural fluid characteristics of chylothorax. Mayo Clin Proc, 2009, 84(2): 129-133.
15.	Ulíbarri JI, Sanz Y, Fuentes C, et al. Reduction of lymphorrhagia from ruptured thoracic duct by somatostatin. Lancet, 1990, 336(8709): 258. doi: 10.1016/0140-6736(90)91793-a.
16.	Kadota H, Kakiuchi Y, Yoshida T. Management of chylous fistula after neck dissection using negative-pressure wound therapy: A preliminary report. Laryngoscope, 2012, 122(5): 997-999.
17.	孙团起. 甲状腺手术后颈部乳糜漏的预防及处理. 中国实用外科杂志, 2018, 38(6): 628-630.
18.	冯嘉麟, 周秦毅, 陈隽, 等. 甲状腺癌中央区淋巴清扫术后乳糜漏的临床分析. 中华耳鼻咽喉头颈外科杂志, 2019, 54(8): 597-600.
19.	Wei T, Liu F, Li Z, et al. Novel management of intractable cervical chylous fistula with local application of pseudomonas aeruginosa injection. Otolaryngol Head Neck Surg, 2015, 153(4): 561-565.
20.	魏涛, 朱信心, 陈锐, 等. 铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后淋巴漏的临床分析. 中国普外基础与临床杂志, 2013, (3): 325-327.
21.	费翔, 崔建春, 毕冬宁, 等. 甲状腺癌中央组淋巴结清扫术后乳糜漏治疗策略及新方法(附2例报道). 中国普外基础与临床杂志, 2020, 27(3): 350-352.

1. Park I, Her N, Choe JH, et al. Management of chyle leakage after thyroidectomy, cervical lymph node dissection, in patients with thyroid cancer. Head Neck, 2018, 40(1): 7-15.
2. Song R, Fei X, Cui J, et al. Treatment strategy for chylous leakage after dissection of central lymph nodes in thyroid cancer. Ann Ital Chir, 2020, 91: 692-696.
3. Chen CY, Chen YH, Shiau EL, et al. Therapeutic role of ultrasound-guided intranodal lymphangiography in refractory cervical chylous leakage after neck dissection: Report of a case and review of the literature. Head Neck, 2016, 38(2): E54-E60. doi: 10.1002/hed.24134.
4. 孙团起, 吴毅. 甲状腺手术乳糜漏发生原因及防治. 中国实用外科杂志, 2012, 32(5): 372-374.
5. 姜军, 李世超. 甲状腺癌—分化型甲状腺癌淋巴结转移特点及颈侧方淋巴结清扫术局部应用解剖. 中国实用外科杂志, 2011, 31(5): 380-383.
6. Tenny BC, Madjarov J, Shipe T, et al. Surgical intervention in a complicated persistent chyle leak. Int J Surg Case Rep, 2018, 42: 7-9.
7. 房忠菊, 张永侠, 赵建东, 等. 甲状腺癌颈清扫术后乳糜漏的综合治疗. 山东大学耳鼻喉眼学报, 2020, 34(3): 64-68.
8. Campisi CC, Boccardo F, Piazza C, et al. Evolution of chylous fistula management after neck dissection. Curr Opin Otolaryngol Head Neck Surg, 2013, 21(2): 150-156.
9. Kannan RR, Mahajan V, Ayyappan S. Management of chyle fistulae following surgery in the neck. Indian J Cancer, 2001, 38(2-4): 117-120.
10. He Q, Zhu J, Zhuang D, et al. Robotic lateral cervical lymph node dissection via bilateral axillo-breast approach for papillary thyroid carcinoma: a single-center experience of 260 cases. J Robot Surg, 2020, 14(2): 317-323.
11. 黄庆锦, 林孝文, 张再重, 等. 乳头状甲状腺癌择区性颈淋巴结清扫术后乳糜漏的比较研究. 中华普通外科学文献(电子版), 2018, 12(1): 54-56.
12. Delaney SW, Shi H, Shokrani A, et al. Management of chyle leak after head and neck surgery: review of current treatment strategies. Int J Otolaryngol, 2017, 2017: 8362874. doi: 10.1155/2017/8362874.
13. Stager V, Le L, Wood RE. Postoperative chylothorax successfully treated using conservative strategies. Proc (Bayl Univ Med Cent), 2010, 23(2): 134-138.
14. Maldonado F, Hawkins FJ, Daniels CE, et al. Pleural fluid characteristics of chylothorax. Mayo Clin Proc, 2009, 84(2): 129-133.
15. Ulíbarri JI, Sanz Y, Fuentes C, et al. Reduction of lymphorrhagia from ruptured thoracic duct by somatostatin. Lancet, 1990, 336(8709): 258. doi: 10.1016/0140-6736(90)91793-a.
16. Kadota H, Kakiuchi Y, Yoshida T. Management of chylous fistula after neck dissection using negative-pressure wound therapy: A preliminary report. Laryngoscope, 2012, 122(5): 997-999.
17. 孙团起. 甲状腺手术后颈部乳糜漏的预防及处理. 中国实用外科杂志, 2018, 38(6): 628-630.
18. 冯嘉麟, 周秦毅, 陈隽, 等. 甲状腺癌中央区淋巴清扫术后乳糜漏的临床分析. 中华耳鼻咽喉头颈外科杂志, 2019, 54(8): 597-600.
19. Wei T, Liu F, Li Z, et al. Novel management of intractable cervical chylous fistula with local application of pseudomonas aeruginosa injection. Otolaryngol Head Neck Surg, 2015, 153(4): 561-565.
20. 魏涛, 朱信心, 陈锐, 等. 铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后淋巴漏的临床分析. 中国普外基础与临床杂志, 2013, (3): 325-327.
21. 费翔, 崔建春, 毕冬宁, 等. 甲状腺癌中央组淋巴结清扫术后乳糜漏治疗策略及新方法(附2例报道). 中国普外基础与临床杂志, 2020, 27(3): 350-352.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

甲状腺癌颈淋巴结清扫术后难治性乳糜漏临床分析

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