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;
PENG Xiaowei, Email: xiaoweipeng619@163.com
lymphatic leak; endoscopic surgery; lateral neck lymph node dissection; papillary thyroid carcinoma; preventive and treatment measure
10.7507/1007-9424.202404056
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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, low-protein 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 field, 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 the surgical field. Patient No.28 recovered after only pectoralis major muscle flap occlusion of the jugular venous angle and continuous strong negative pressure suction postoperatively. Treatment process of patient No.30 was the same as Patient No.1. Patient No.36 was treated with pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, and continuous strong negative pressure suction postoperatively. Through the stepwise sequential treatment measures, all 5 patients successfully recovered from lymphatic leakage; the postoperative hospital stay ranged from 3 to 17 days, with an average of 8.6 days. Conclusions The stepwise sequential treatment plan used in this study can effectively prevent and treat lymphatic leakage after transoral endoscopic thyroid cancer lateral neck lymph node dissection. Given the small sample size of this study, we believe it is necessary to conduct long-term studies to confirm the durability and stability of these measures.