甲状腺癌颈淋巴结清扫术后淋巴管漏及胸导管漏处理体会_医学论文.docVIP

甲状腺癌颈淋巴结清扫术后淋巴管漏及胸导管漏处理体会_医学论文 甲状腺癌颈淋巴结清扫术后淋巴管漏及胸导管漏处理体会_医学论文 【摘要】 目的 探讨甲状腺癌颈淋巴结清扫术后淋巴管漏和乳糜漏的原因，诊断及处理体会。方法 回顾分析842例甲状腺癌行颈部淋巴结清扫术及术后发生淋巴管漏或乳糜漏的25例患者的临床病历资料。结果 术中发现胸导管损伤5例，予结扎处理，术后未发生乳糜漏或淋巴瘘。术后发生淋巴管漏14 例，左侧4 例，右侧10例；发生胸导管漏11例；左侧10例，右侧1例。所有患者都给持续负压引流及局部压迫处理，部分患者给予饮食控制和肠外营养支持治疗。淋巴管漏的14例患者于1周内治愈，胸导管漏的8例于2周内治愈，其余3例超过1月，最长1例45天治愈。结论 术中恰当的处理可以有效避免术后淋巴管或胸导管漏的发生，术后一旦发现淋巴管漏或胸导管漏应及时给予持续负压引流，局部加压包扎和合理的饮食控制及及营养支持等保守治疗可获满意疗效。 【关键词】 甲状腺癌 颈淋巴结清扫术 淋巴管漏 乳糜瘘 治疗 【Abstract】 Objective To investigate the cause of lymphatic vessel leak and chyle leakage following neck dissection in papillary thyroid cancer patient. Methods 842cases were performed neck dissection, among them, 25 had postoperative lymphatic vessel leak or chylous fistula were retrospectively analyzed. Results Intraoperative chyle leakage was observed in 5 patient, all on the left side and all controlled by suturing chyle fistula, thus avoiding postoperative leakage. lymphatic vessel leak occurred in 14 patients,10 in right, 4 in left chylous fistula occurred in 11patients,10 in left,1in right. High negative pressure drainage and pressure dressing were applied in all patients, reasonable dietry control and perenteral nutrition support were applied in partial patients.Lymphatic vessel leak stopped in 14 patients within one week, 8 of chylous fistula stopped within 2 weeks, the other 3 stopped one month later. None of them underwent reoperation.Conclusion Postoperative lymphatic vessel leak or chylous fistula can be avioded by careful neck dissection in at-risk area duing operation. Proper postoperative conservative management is of great help when leakage occurred. 【Key words】Thyroid cancer Neck dissection Chyle leakage Management 颈部淋巴结转移为甲状腺癌最常见的转移方式，手术根治及淋巴结清扫仍为治疗的主要手段[1]。术后发生乳糜漏为棘手并发症，我院自1998年-2007年共开展颈淋巴结清扫的甲状腺癌手术842例，术中发现左侧胸导管瘘5例，进行缝扎处理，术后无一例发生乳糜漏。25例发生术后淋巴管漏及胸导管漏，均经非手术治疗治愈，现报道如下: 1 材料与方法 1.1 一般资料 本组25例，女性17例，男性8例，年龄19～69岁。18例以甲状腺包块和/或颈淋巴结肿大就诊，2例为颈淋巴结活检发现甲状腺癌转移，5例为甲状腺癌根治术后同侧颈部淋巴节转移再次手术。所有病例术后病理学检查均证实为甲状腺乳头状癌并颈淋巴结转移。 1