Clinical effect of refractory chylous leakage treated by Jindan Fuyan Granule after neck lymph node dissection for thyroid cancer: a report of 3 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GUO Nannan , YAO Zhangyu , JU Guoyuan , GUI Bo , YAO Weiping , HAO Hanxia , CHEN Wei , ZHAO Yanbin , QIAN Yichun ,  LIU Fangzhou

Department of Head and Neck Surgery, Jiangsu Cancer Hospital, Nanjing 210009, P. R. China;

Corresponding?author：

LIU Fangzhou, Email: liufangzhou@njmu.edu.cn

Keywords：

Jindan Fuyan Granule; refractory chylous leakage; thyroid cancer; neck lymph node dissection

DOI：

10.7507/1007-9424.202404083

Video：

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Objective To summarize the efficacy and safety of Jindan Fuyan Granule in the treatment of refractory chylous leakage after neck lymph node dissection for thyroid cancer. Method The clinical data of thyroid cancer patients with refractory chylous leakage after neck lymph node dissection treated with Jindan Fuyan Granules in the Department of Head and Neck Surgery of Jiangsu Cancer Hospital from January to December 2023, were retrospectively collected. Results After treatment with Jindan Fuyan Granules on the basis of conventional treatment, the drainage volume of 3 patients with thyroid cancer after radical neck lymph node dissection was significantly reduced, from 100 mL to 2 mL, 1 285 mL to 5 mL, and 960 mL to 5 mL, respectively. After 3 days of treatment, the tubes were removed successfully. After discharge from the hospital, 3 patients were followed up for 3, 3, 4 months, respectively, showing satisfactory wound healing without chylous leakage or other discomfort. Conclusions Combined with low-fat diet, drainage and other non-surgical treatment methods, Jindan Fuyan Granule has obvious effect on treating refractory chylous fistula after neck lymph node dissection, which can be used as a non-surgical treatment option. However, the efficacy needs to be further verified.

Citation： GUO Nannan, YAO Zhangyu, JU Guoyuan, GUI Bo, YAO Weiping, HAO Hanxia, CHEN Wei, ZHAO Yanbin, QIAN Yichun, LIU Fangzhou. Clinical effect of refractory chylous leakage treated by Jindan Fuyan Granule after neck lymph node dissection for thyroid cancer: a report of 3 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(11): 1319-1323. doi: 10.7507/1007-9424.202404083 Copy

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13.	Pines G, Malka Yosef L, Lazar LO, et al. Negative-pressure vacuum therapy for high-output chyle leak following neck dissection. Innovations (Phila), 2020, 15(5): 481-483.
14.	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.
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19.	Stanisce L, Lai M, Ahmad N, et al. Outcomes associated with fibrin sealant use in lateral neck dissections. OTO Open, 2020, 4(4): 2473974X20981021.
20.	王勇飛, 殷德濤. 高滲糖局部注射治療甲狀腺癌頸部淋巴結清掃術后淋巴漏療效分析. 中國實用外科雜志, 2019, 39(6): 615-618.
21.	Ma Y, Zeng C, Hou P, et al. Pseudomonas aeruginosa injection decreases drainage in lateral neck dissection for metastatic thyroid cancer. Gland Surg, 2020, 9(5): 1543-1550.
22.	Chen Q, Chen Y, Su A, et al. Ultrasound-guided percutaneous injection of Pseudomonas aeruginosa-mannose sensitive hemagglutinin for treatment of chyle fistula following neck dissection: two case reports. Medicine (Baltimore), 2020, 99(5): e18816.
23.	Co?kun A, Yildirim M. Somatostatin in medical management of chyle fistula after neck dissection for papillary thyroid carcinoma. Am J Otolaryngol, 2010, 31(5): 395-396.
24.	Swanson MS, Hudson RL, Bhandari N, et al. Use of octreotide for the management of chyle fistula following neck dissection. JAMA Otolaryngol Head Neck Surg, 2015, 141(8): 723-727.
25.	Jain A, Singh SN, Singhal P, et al. A prospective study on the role of octreotide in management of chyle fistula neck. Laryngoscope, 2015, 125(7): 1624-1627.
26.	Molena E, King E, Davies-Husband C. Octreotide versus oral dietary modification for the treatment of chylous fistula following neck dissection: a systematic review and meta-analysis. Clin Otolaryngol, 2021, 46(3): 474-484.
27.	Murphy E, Prommer EE, Mihalyo M, et al. Octreotide. J Pain Symptom Manage, 2010, 40(1): 142-148.
28.	孫寶, 白延寧, 張媛媛, 等. 110例奧曲肽不良反應文獻分析. 中國藥物應用與監測, 2020, 17(4): 253-257,286.
29.	Shibuya Y, Asano K, Hayasaka A, et al. A novel therapeutic strategy for chylous ascites after gynecological cancer surgery: a continuous low-pressure drainage system. Arch Gynecol Obstet, 2013, 287(5): 1005-1008.
30.	杜敏, 方小玲, 夏曉夢. 婦科惡性腫瘤術后淋巴漏的診治. 現代婦產科進展, 2019, 28(12): 952-953, 956.
31.	Smoke A, Delegge MH. Chyle leaks: consensus on management? Nutr Clin Pract, 2008, 23(5): 529-532.
32.	Ashoor A, Lissidini G, Datta U, et al. Chyle leak after axillary node clearance in breast cancer surgery-a rare complication and a proposed management strategy from the british and italian experience. Ann Surg Oncol, 2022, 29(13): 7992-7999.
33.	周素梅, 張筱驊, 郭貴龍, 等. 持續強負壓吸引聯合靜脈營養治療甲狀腺癌頸淋巴結清掃術后乳糜漏. 實用腫瘤雜志, 2008, 23(5): 454-455.
34.	Santaolalla F, Anta JA, Zabala A, et al. Management of chylous fistula as a complication of neck dissection: a 10-year retrospective review. Eur J Cancer Care (Engl), 2010, 19(4): 510-515.
35.	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.
36.	王剛, 于芳, 范子義, 等. 甲狀腺癌頸淋巴結清掃術后難治性乳糜漏臨床分析. 中國普外基礎與臨床雜志, 2022, 29(4): 517-521.
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1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
3. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
4. 賀青卿, 于芳, 范子義, 等. 單中心2 038例甲狀腺癌20年隨訪及危險因素分析. 中華內分泌外科雜志, 2022, 16(1): 18-22.
5. Ducic Y, Young L, McIntyre J. Neck dissection: past and present. Minerva Chir, 2010, 65(1): 45-58.
6. Brennan PA, Blythe JN, Herd MK, et al. The contemporary management of chyle leak following cervical thoracic duct damage. Br J Oral Maxillofac Surg, 2012, 50(3): 197-201.
7. 賀青卿, 田文, 朱精強, 等. 甲狀腺癌頸淋巴結清掃術后乳糜漏防治中國專家共識 (2022版). 中國實用外科雜志, 2022, 42(6): 616-620.
8. 劉方舟, 虞同華, 趙衛平, 等. 生長抑素對頸淋巴結清掃術后乳糜漏的療效觀察. 中國腫瘤外科雜志, 2013, 5(2): 84-86.
9. 尹玉月. 金丹附延顆粒治療濕熱內蘊型慢性盆腔炎的有效性與安全性臨床研究. 宜春: 宜春學院, 2019.
10. 陳凌燕. 金丹附延顆粒治療慢性盆腔痛(濕熱內蘊證)的效果觀察及安全性評價. 中國醫學創新, 2018, 15(36): 44-48.
11. 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.
12. Dorneden A, Olson G, Boyd N. Negative pressure wound therapy (wound vac) in the treatment of chylous fistula after neck dissection. Ann Otol Rhinol Laryngol, 2019, 128(6): 569-574.
13. Pines G, Malka Yosef L, Lazar LO, et al. Negative-pressure vacuum therapy for high-output chyle leak following neck dissection. Innovations (Phila), 2020, 15(5): 481-483.
14. 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.
15. 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.
16. 南琳, 王江, 張永久, 等. 分化型甲狀腺癌頸淋巴結清掃術后淋巴漏治療體會. 中國實用外科雜志, 2015, 35(5): 556.
17. 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.
18. Anestis N, Christos FC, Ioannis P, et al. Thoracic duct injury due to left subclavicular vein catheterization: a new conservative approach to a chyle fistula using biological glue. Int J Surg Case Rep, 2012, 3(7): 330-332.
19. Stanisce L, Lai M, Ahmad N, et al. Outcomes associated with fibrin sealant use in lateral neck dissections. OTO Open, 2020, 4(4): 2473974X20981021.
20. 王勇飛, 殷德濤. 高滲糖局部注射治療甲狀腺癌頸部淋巴結清掃術后淋巴漏療效分析. 中國實用外科雜志, 2019, 39(6): 615-618.
21. Ma Y, Zeng C, Hou P, et al. Pseudomonas aeruginosa injection decreases drainage in lateral neck dissection for metastatic thyroid cancer. Gland Surg, 2020, 9(5): 1543-1550.
22. Chen Q, Chen Y, Su A, et al. Ultrasound-guided percutaneous injection of Pseudomonas aeruginosa-mannose sensitive hemagglutinin for treatment of chyle fistula following neck dissection: two case reports. Medicine (Baltimore), 2020, 99(5): e18816.
23. Co?kun A, Yildirim M. Somatostatin in medical management of chyle fistula after neck dissection for papillary thyroid carcinoma. Am J Otolaryngol, 2010, 31(5): 395-396.
24. Swanson MS, Hudson RL, Bhandari N, et al. Use of octreotide for the management of chyle fistula following neck dissection. JAMA Otolaryngol Head Neck Surg, 2015, 141(8): 723-727.
25. Jain A, Singh SN, Singhal P, et al. A prospective study on the role of octreotide in management of chyle fistula neck. Laryngoscope, 2015, 125(7): 1624-1627.
26. Molena E, King E, Davies-Husband C. Octreotide versus oral dietary modification for the treatment of chylous fistula following neck dissection: a systematic review and meta-analysis. Clin Otolaryngol, 2021, 46(3): 474-484.
27. Murphy E, Prommer EE, Mihalyo M, et al. Octreotide. J Pain Symptom Manage, 2010, 40(1): 142-148.
28. 孫寶, 白延寧, 張媛媛, 等. 110例奧曲肽不良反應文獻分析. 中國藥物應用與監測, 2020, 17(4): 253-257,286.
29. Shibuya Y, Asano K, Hayasaka A, et al. A novel therapeutic strategy for chylous ascites after gynecological cancer surgery: a continuous low-pressure drainage system. Arch Gynecol Obstet, 2013, 287(5): 1005-1008.
30. 杜敏, 方小玲, 夏曉夢. 婦科惡性腫瘤術后淋巴漏的診治. 現代婦產科進展, 2019, 28(12): 952-953, 956.
31. Smoke A, Delegge MH. Chyle leaks: consensus on management? Nutr Clin Pract, 2008, 23(5): 529-532.
32. Ashoor A, Lissidini G, Datta U, et al. Chyle leak after axillary node clearance in breast cancer surgery-a rare complication and a proposed management strategy from the british and italian experience. Ann Surg Oncol, 2022, 29(13): 7992-7999.
33. 周素梅, 張筱驊, 郭貴龍, 等. 持續強負壓吸引聯合靜脈營養治療甲狀腺癌頸淋巴結清掃術后乳糜漏. 實用腫瘤雜志, 2008, 23(5): 454-455.
34. Santaolalla F, Anta JA, Zabala A, et al. Management of chylous fistula as a complication of neck dissection: a 10-year retrospective review. Eur J Cancer Care (Engl), 2010, 19(4): 510-515.
35. 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.
36. 王剛, 于芳, 范子義, 等. 甲狀腺癌頸淋巴結清掃術后難治性乳糜漏臨床分析. 中國普外基礎與臨床雜志, 2022, 29(4): 517-521.
37. 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.
38. 孫苗苗, 李鵬. 二黃牡丹湯治療慢性盆腔炎后遺癥療效觀察及對血清IL-8、MCP-1、MMP-2水平的影響. 新中醫, 2023, 55(14): 93-97.
39. 杜菲菲. 中藥溫灸治療慢性盆腔痛的療效觀察. 實用婦科內分泌電子雜志, 2015, 2(7): 47-48.
40. 代學營, 劉秀華, 王沛沛. 紅藤敗醬湯加減治療慢性盆腔炎的臨床效果分析. 中國實用醫藥, 2023, 18(16): 121-124.
41. 張雪梅, 王秀萍, 張金麗. 紅藤湯內服聯合盆腔炎湯灌腸治療慢性盆腔炎濕熱瘀阻型臨床觀察. 實用中醫藥雜志, 2023, 39(11): 2105-2107.
42. 王映紅, 徐應利. 清熱祛濕化瘀湯治療濕熱瘀結型慢性盆腔炎伴炎性包塊療效觀察. 河北中醫, 2023, 45(10): 1685-1688, 1692.
43. 楊衛靈, 劉春麗, 梁文珍, 等. 梁文珍治療慢性盆腔炎經驗. 時珍國醫國藥, 2014, 25(4): 960-961.
44. 楊崇一, 戴希望, 劉杰, 等. 除濕活血化瘀方治療慢性盆腔炎的療效觀察及對血液流變學、CRP水平的影響. 中國中醫藥科技, 2023, 30(6): 1159-1161.
45. 王妍, 馮婷婷, 魏紹斌. 從濕邪致病論探討婦科慢性盆腔疼痛病癥的新思路. 時珍國醫國藥, 2014, 25(3): 676-677.
46. 湯芳梅, 王麗, 田日升, 等. 盆炎消顆粒治療慢性盆腔炎療效觀察. 陜西中醫學院學報, 2012, 35(5): 55-56, 61.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical effect of refractory chylous leakage treated by Jindan Fuyan Granule after neck lymph node dissection for thyroid cancer: a report of 3 cases

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