摘要
目的探讨甲状腺癌中央区淋巴结清扫术后发生乳糜漏的原因和治疗方法。方法选取烟台毓璜顶医院甲状腺外科2016年8月~2019年12月2578例甲状腺癌中央区淋巴结清扫术病例,观察术后引流液的量、性状的变化及发生变化的时间,根据诊断标准判断患者乳糜漏的发生。结果其中23例患者术后出现了中央区乳糜漏,发生率为0.9%(23/2578)。发生中央区乳糜漏后,给予禁饮食、持续强负压吸引、应用生长抑素,短期的治疗效果不佳者,辅以加压包扎、创腔注射高渗糖或泛影葡胺等痊愈,治疗时间最长38 d,无二次开放手术治疗的病例。结论甲状腺癌淋巴结清扫术后中央区乳糜漏的发生率相对较低,术后1~2 d引流量异常增多或引流液性状改变时应警惕中央区乳糜漏的发生,及时采取相应的禁饮食、持续强负压吸引、应用生长抑素等措施,基本上均可保守治愈。
Objective To explore the causes and treatment of chylous leakage after central lymph node dissection in thyroid carcinoma.Methods A total of 2578 cases of lymph node dissection in the central region of thyroid cancer in the Department of Thyroid Surgery of Yuhuangding Hospital in Yantai from August 2016 to December 2019 were selected.The changes in the amount and characteristics of postoperative drainage fluid,as well as the time of change were observed.The occurrence of chylous leakage in patients was determined according to the diasgnostic criteria.Results A total of 23 patients had chylous leakage in central region,and the occurrence rate was 0.9%(23/2578).After the occurrence of chylous leakage in central region,patients were given diet abstinence,continuous strong negative pressure suction,application of somatostatin,and short-term treatment effect was poor.The patients were recovered after the supplement of pressure dressing,invasive injection of hyperosmotic sugar or meglumine pandiumine.The longest treatment time was up to 38 days,and there were no cases of secondary open surgery.Conclusion The incidence of postoperative central region chylous leakage in thyroid carcinoma is relatively low.The occurrence of chylous leakage in central region should be warned when the drainage volume increases abnormally or the characteristics of drainage fluid change 1-2 days after operation.The corresponding measures such as prohibition of diet,continuous strong negative pressure attraction and application of somatostatin should be taken timely.And the patients can be basically conservatively cured.
作者
刘洋
吴国长
孙海清
郑桂彬
马驰
郑海涛
LIU Yang;WU Guochang;SUN Haiqing;ZHENG Guibin;MA Chi;ZHENG Haitao(Department of Thyroid Surgery,Yuhuangding Hospital of Yantai in Shandong Province,Yantai264000,China)
出处
《中国现代医生》
2020年第26期56-59,共4页
China Modern Doctor
关键词
甲状腺癌
淋巴结清扫
并发症
乳糜漏
防治
Thyroid carcinoma
Lymph node dissection
Complications
Chylous leakage
Prevention and treatment
