甲状腺癌联合根治术后乳糜瘘的治疗体会

Experience in treating chylous fistula after radical resection for thyroid carcinoma

目的总结甲状腺癌联合根治术后乳糜瘘的治疗效果。方法回顾性分析我院1992~2010年18例甲状腺癌联合根治术后乳糜瘘的临床资料。18例中,乳糜瘘发生在左侧15例,右侧3例。13例采用负压吸引、局部加压、低脂饮食或同时给予皮瓣下注入50%葡萄糖的保守治疗;5例接受手术治疗。结果 18例中,15例（83.3%）的乳糜瘘发生于手术后的最初3 d。13例保守治疗结果：8例获得痊愈,愈合时间为4~30 d,中位时间9.7 d;5例失败,经手术治疗而痊愈,愈合时间为2~37 d,中位时间15.4 d。结论甲状腺癌联合根治术后的乳糜瘘经合理地治疗是可以治愈的,并不延长患者的住院时间。对乳糜量每日少于500 ml的早期乳糜瘘可采用保守治疗;对保守治疗短期内无效及乳糜量每日超过500 ml的患者,应及时采用手术治疗。

Objective To summarize the experience in treating chylous fistula after radical resection for thyroid carcinoma.Methods Data of 18 patients with chylous fistulas from 1992 to 2010 were retrospectively analyzed.Of 18 cases,chylous fistula occured on the left side in 15 patients,and on the right side in 3 cases.Operation was performed in 5 cases and conservative therapy was taken in 13 cases,which included wound close drainage combined with local pressure dressing,low-fat nutritional support and/or 50% glucose injection under the skin flap.Results The chylous fistula in 15（83.3%） cases occured within the first 3 days after operation.Of 13 cases underwent conservative therapy,the chylous fistula was cured in 8 cases within 4-30 d,and 5 cases had to be operated with fistula-cured time of 2-37 d.Conclusion The chylous fistula after radical resection for thyroid carcinoma can be cured with reasonable treatment without influence on the hospital stay.The conservative therapy should be employed in the patients with a maximal production of chyle below 500 ml a day.Surgery should be taken early in the cases with a maximal production of chyle greater than 500 ml a day or in those with failured conservative treatment for a few days.