Objective To investigate the function of a self-designed bilayered negative pressure wound therapy (b-NPWT) in reducing the occurrence of these complications through a clinical randomized controlled trial. Methods We included 72 coronary heart disease patients in our hospital from December 2013 through March 2014. There were 48 males and 24 females aged 38.4±18.6 years undergoing coronary artery bypass graft(CABG) surgery, and great saphenous veins were chosen as grafts. Patients were equally randomized into a trial group and a control group. The patients in the trial group underwent 5 d of b-NPWT for thigh incision and interrupted suture for shank incision after the harvesting of great saphenous veins. Patients in the control group received an interrupted suture for both thigh incision and shank incision after the harvesting of great saphenous veins. We evaluated the function of b-NPWT by reducing the complications arising from the harvesting of great saphenous veins in CABG patients. Results The incidences of early complications, such as lymphedema, incision infection, non-union, and skin flap necrosis of the vascular zone in the trial group were significantly lower than those of the control group. There was no death or new problem in heart or deep venous thrombosis in both groups. No complication occurred in long term. The incidence of lower limb edema was lower in the trial group than that in the control group at the end of 3 months follow-up. Conclusion B-NPWT can effectively prevent lymphorrhagia in CABG patients who underwent the harvesting of great saphenous veins. It can also reduce the incidence of complications and discomfort of the patients.
目的 探討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方法及效果。方法 筆者所在醫院2012年4月至2012年7月期間共治療甲狀腺癌頸部淋巴結清掃術后頑固性淋巴漏患者4例，均采用銅綠假單胞菌注射液治療。將銅綠假單胞菌注射液（1mL或2mL）通過引流管逆行注射到創腔，夾閉引流管1h后再開放引流管。結果 4例患者注射前1d24h引流量分別為200、350、540及810mL，其中2例患者為乳糜漏，引流時間分別為7d和15d；另2例患者為單純淋巴漏，引流時間分別為13d和14d。注射1d后，引流量分別減少至20、45、120及255mL，4d后4例患者均順利拔除引流管。4例患者治療后均有不同程度的發熱，經物理降溫后體溫恢復；均有不同程度的局部疼痛感，3例患者疼痛能耐受，另1例疼痛劇烈患者予以美洛昔康口服后緩解。結論 銅綠假單胞菌注射液治療甲狀腺癌頸部淋巴結清掃術后頑固性淋巴漏的療效顯著。
ObjectiveTo summarize the prevention and treatment strategies and their effects on lymphatic leakage following transoral endoscopic thyroid cancer lateral neck lymph node dissection. MethodsA 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. ResultsOut 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 cavity, 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 cavity. Patient No.28 recovered after only pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet and continuous strong negative pressure suction postoperatively. Treatment process of patient No.30 was the same as Patient No.1, Patient No.36 was the same as Patient No.20. 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. ConclusionsThe 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 that it is necessary to conduct long-term studies to confirm the durability and stability of these measures.