甲状腺癌中央区淋巴结清除术后乳糜漏的防治

2016-03-31郝伟静于洋郑向前杨晓勇赵敬柱董莉阮先辉彭琛池嘉栋高明

中国肿瘤临床 2016年2期

关键词：手术

郝伟静　于洋　郑向前　杨晓勇　赵敬柱　董莉　阮先辉　彭琛　池嘉栋　高明

甲状腺癌中央区淋巴结清除术后乳糜漏的防治

郝伟静于洋郑向前杨晓勇赵敬柱董莉阮先辉彭琛池嘉栋高明

摘要目的：探讨甲状腺癌中央区淋巴结清除术后乳糜漏发生的原因及有效的防治措施。方法：选取天津医科大学肿瘤医院2013年7月至2015年6月6 127例甲状腺癌中央区淋巴结清除术病例，其中14例患者术后并发乳糜漏。采取全身治疗、局部加压包扎、常压引流、50%葡萄糖注射液或平阳霉素经引流管注入等保守治疗，保守治疗效果不理想时行手术治疗。结果：12例患者行保守治疗后，引流量逐渐减少，至<10 mL/d时拔除引流管；2例患者保守治疗后，引流量未见明显减少，行手术治疗。结论：甲状腺癌中央区淋巴结清除术时应仔细操作以预防乳糜漏的发生，发生后行保守治疗，保守治疗无效时行手术治疗。

关键词甲状腺癌中央区淋巴结清除术并发症乳糜漏防治

Prevention and treatment of chylous fistula after central lymph node dissection of thyroid cancer

Weijing HAO, Yang YU, Xiangqian ZHENG, Xiaoyong YANG, Jingzhu ZHAO, Li DONG, Xianhui RUAN, Chen PENG, Jiadong CHI, Ming GAO
Correspondence to: Ming GAO; E-mail: yunspider@126.com
Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China

Abstract Objective: To discuss the causes and effective measures of prevention and treatment of chylous fistula after central lymph node dissection（CLND）of thyroid cancer.Methods: A total of 6 127 patients who underwent CLND of thyroid cancer in the Tianjin Medical University Cancer Institute and Hospital between July 2013 and June 2015 were analyzed; of which, 14 patients acquired the complication of postoperative chylous fistula.The following conservative treatments were initially performed: systemic therapy, local pressure bandaging, normal pressure drainage, 50% glucose injection, or pingyangmycin injection through a drainage tube.Surgical operation was then conducted when the efficacy of the treatment was poor.Results: After the conservative treatment of the 14 patients, the drainage volume gradually decreased in 12 patients, and surgery was performed on the remaining two patients.Conclusion: The CLND of thyroid cancer must be carefully conducted to prevent postoperative chylous fistula.An active conservative treatment must be the first option when chylous fistula occurs.Surgery must only be performed if the treatment is invalid.

Keywords:thyroid cancer, central lymph node dissection, complication, chylous fistula, prevention and treatment

乳糜漏是甲状腺癌颈淋巴结清除术少见但较严重的并发症，发生率为1.0%～5.8%，且多见于侧颈淋巴结清除术，中央区淋巴结清除术后乳糜漏的发生鲜见报道。颈部胸导管及其分支的术中损伤是造成乳糜漏的最主要原因。乳糜漏发生后若处理不当，大量乳糜液丢失，不仅容易引起患者血容量减少、电解质紊乱，还可导致皮瓣坏死、局部感染，有的甚至可继发颈部大血管破裂、乳糜胸或全身衰竭死亡。本研究对甲状腺癌中央区淋巴结清除术后乳糜漏发生的原因及防治措施进行了初步探讨。