甲狀腺癌頸淋巴結清掃術后難治性乳糜漏臨床分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

王剛 , 于芳 , 范子義 , 王猛 , 王丹 , 周鵬 , 李小磊 , 厲彥辰 ,  賀青卿

解放軍第九六〇醫院甲狀腺乳腺外科（濟南 250031）;

Corresponding?author：

賀青卿, Email: heqingqing@yeah.net

Keywords：

甲狀腺癌; 乳糜漏; 頸淋巴結清掃術; 淋巴管瘺結扎術

DOI：

10.7507/1007-9424.202107107

Video：

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目的分析甲狀腺癌手術后難治性乳糜漏的臨床特點，探討難治性乳糜漏的治療策略。方法回顧性分析解放軍第九六〇醫院（原濟南軍區總醫院）2009年 1 月至 2021 年1 月期間收治的 5 021例行甲狀腺癌頸淋巴結清掃術患者的臨床資料，術后發生乳糜漏122例，其中治療時間超過2周的難治性乳糜漏34例，對難治性乳糜漏患者的一般情況、治療方式、峰值引流量（日最高引流量）、帶管時間等進行分析總結。結果 5 021例患者中發生乳糜漏122例，占所有患者的2.4%。經非手術治療2周內治愈者88例，占乳糜漏總數的72.1%；治療時間超過2周的難治性乳糜漏34例，占乳糜漏總數的27.9%。難治性乳糜漏經非手術方法治愈者18例，經再次手術治愈者16例，2組患者的乳糜漏位置左側多于右側；34例難治性乳糜漏峰值引流量（日最高引流量）手術組（16例）高于非手術組（P<0.05），帶管時間手術組短于非手術組（P<0.05）。結論低峰值引流量乳糜漏經非手術治療多可治愈；難治性乳糜漏左側多見，高流量乳糜漏（峰值引流量≥1 000 mL）宜早期實施手術治療。

Citation： 王剛, 于芳, 范子義, 王猛, 王丹, 周鵬, 李小磊, 厲彥辰, 賀青卿. 甲狀腺癌頸淋巴結清掃術后難治性乳糜漏臨床分析. 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.	孫團起, 吳毅. 甲狀腺手術乳糜漏發生原因及防治. 中國實用外科雜志, 2012, 32(5): 372-374.
5.	姜軍, 李世超. 甲狀腺癌—分化型甲狀腺癌淋巴結轉移特點及頸側方淋巴結清掃術局部應用解剖. 中國實用外科雜志, 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, 張永俠, 趙建東, 等. 甲狀腺癌頸清掃術后乳糜漏的綜合治療. 山東大學耳鼻喉眼學報, 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.	黃慶錦, 林孝文, 張再重, 等. 乳頭狀甲狀腺癌擇區性頸淋巴結清掃術后乳糜漏的比較研究. 中華普通外科學文獻(電子版), 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.	孫團起. 甲狀腺手術后頸部乳糜漏的預防及處理. 中國實用外科雜志, 2018, 38(6): 628-630.
18.	馮嘉麟, 周秦毅, 陳雋, 等. 甲狀腺癌中央區淋巴清掃術后乳糜漏的臨床分析. 中華耳鼻咽喉頭頸外科雜志, 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.	魏濤, 朱信心, 陳銳, 等. 銅綠假單胞菌注射液治療甲狀腺癌頸部淋巴結清掃術后淋巴漏的臨床分析. 中國普外基礎與臨床雜志, 2013, (3): 325-327.
21.	費翔, 崔建春, 畢冬寧, 等. 甲狀腺癌中央組淋巴結清掃術后乳糜漏治療策略及新方法(附2例報道). 中國普外基礎與臨床雜志, 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. 孫團起, 吳毅. 甲狀腺手術乳糜漏發生原因及防治. 中國實用外科雜志, 2012, 32(5): 372-374.
5. 姜軍, 李世超. 甲狀腺癌—分化型甲狀腺癌淋巴結轉移特點及頸側方淋巴結清掃術局部應用解剖. 中國實用外科雜志, 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, 張永俠, 趙建東, 等. 甲狀腺癌頸清掃術后乳糜漏的綜合治療. 山東大學耳鼻喉眼學報, 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. 黃慶錦, 林孝文, 張再重, 等. 乳頭狀甲狀腺癌擇區性頸淋巴結清掃術后乳糜漏的比較研究. 中華普通外科學文獻(電子版), 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. 孫團起. 甲狀腺手術后頸部乳糜漏的預防及處理. 中國實用外科雜志, 2018, 38(6): 628-630.
18. 馮嘉麟, 周秦毅, 陳雋, 等. 甲狀腺癌中央區淋巴清掃術后乳糜漏的臨床分析. 中華耳鼻咽喉頭頸外科雜志, 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. 魏濤, 朱信心, 陳銳, 等. 銅綠假單胞菌注射液治療甲狀腺癌頸部淋巴結清掃術后淋巴漏的臨床分析. 中國普外基礎與臨床雜志, 2013, (3): 325-327.
21. 費翔, 崔建春, 畢冬寧, 等. 甲狀腺癌中央組淋巴結清掃術后乳糜漏治療策略及新方法(附2例報道). 中國普外基礎與臨床雜志, 2020, 27(3): 350-352.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

甲狀腺癌頸淋巴結清掃術后難治性乳糜漏臨床分析

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