超声刀颈淋巴结清扫术后乳糜瘘

Chyle Fistula after Neck Radical Dissection Using Harmonic Scalpel

目的探讨超声刀颈淋巴结清扫术后发生乳糜瘘的原因及处理方法。方法回顾性分析四川大学华西医院2005年1月至2009年4月期间105例使用超声刀及110例使用传统方法行左颈或双颈淋巴结清扫的甲状腺癌患者的乳糜瘘的发生情况。结果 105例使用超声刀行左颈或双颈淋巴结清扫术后发生乳糜瘘6例,发生率为5.71%,110例未使用超声刀行左颈或双颈淋巴结清扫术后发生乳糜瘘1例,发生率为0.91%,前者明显高于后者(P<0.05)。结论超声刀行左颈或双颈淋巴结清扫增加了术后发生乳糜瘘的风险,在解剖左颈内静脉下段及左颈静脉角时,显露并保护胸导管,使用丝线结扎的传统方法可有效避免术后发生乳糜瘘。

Objective To investigate the cause and treatment for chyle fistula after neck radical dissection using harmonic scalpel. Methods From January 2005 to April 2009, 105 patients with thyroid carcinoma underwent thyroidectomy by harmonic scalpel （harmonic scalpel group） and 110 patients with thyroid carcinoma by convention- al procedures （conventional group）. Postoperative chyle fistula in all the cases was studied retrospectively. Results The incidence of chyle fistula was 5.71% （6 of 105 patients） in the harmonic scalpel group and 0.91% （l of 110 pa- tients） in the conventional group. The difference was significant between two groups （P〈0.05）. Conclusions Har- monic scalpel increases the risk of chyle fistula in neck radical dissection. The conventional procedures with exposing and preserving or ligating the thoracic duct can reduce the risk significantly.