甲状腺癌中央区淋巴清扫术后乳糜漏的临床分析

Analysis of chyle leakage after central lymph node dissection for thyroid carcinoma

目的分析甲状腺癌中央区淋巴清扫术后乳糜漏的临床特点、治疗措施及预后.方法回顾性分析自2017年1月至2018年6月于上海交通大学医学院附属仁济医院头颈外科接受甲状腺癌根治术+中央区淋巴清扫术的患者985例,将未发生乳糜漏的患者归为A组,973例,发生乳糜漏的患者归为B组,12例.将B组患者中行左侧中央区淋巴清扫的患者归为B1组(5例),行右侧中央区淋巴清扫的患者归为B2组(7例),发生乳糜漏患者予无脂饮食及负压引流治疗.以SPSS20.0软件统计分析B1、B2两组患者的一般情况、手术病理、术后引流量、住院天数、治疗情况和预后.结果甲状腺癌中央区淋巴清扫术后乳糜漏发生率1.2%(12/985).A组患者与B组患者相比,年龄、性别、原发灶大小、中央区淋巴结清扫个数和中央区淋巴结转移个数差异均无统计学意义(P值均>0.05)A组患者术后第1天引流量[(51.7±26.7)ml]及平均住院天数[(3.4±0.8)d],均明显低于B组患者([(131.3±56.0)ml、(10.4±2.6)d],差异有统计学意义(t值分别为-5.442、-11.238,P值均<0.001).B1组和B2组之间,患者年龄、原发灶大小、中央区淋巴结清扫个数、中央区淋巴结转移个数、术后第1天引流量和平均住院天数差异均无统计学意义(P值均>0.05).B组患者乳糜漏均为保守治疗成功,无一例进行二次手术治疗.结论甲状腺癌中央区淋巴清扫术后乳糜漏是一比较少见的术后并发症,可通过饮食控制、加压包扎及负压引流等保守治疗而治愈,一般无需二次手术治疗.

Objective To analyze the clinical characteristics, treatment and prognosis of chyle leakage after central lymph node dissection for thyroid cancer. Methods A retrospective analysis was made of 985 patients who underwent surgical for thyroid carcinoma plus central lymph node dissection from January 2017 to June 2018 in Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University. Patients were divided into those without (group A, n=973) and with (group B, n=12) chyle leakage. Patients with chyle leakage who underwent left central lymph node dissection were divided into group B1 (n=5) and right central lymph node dissection into group B2 (n=7). Patients with chyle leakage were treated with fat-free diet and negative pressure drainage. SPSS 20.0 software was used to analyze the general condition, surgical pathology, postoperative drainage, hospitalization days, treatment and prognosis of patients in B1 and B2 groups. Results The incidence of chyle leakage after central lymph node dissection for thyroid cancer was 1.2%(12/985). There were no significant differences in age, sex, size of primary lesion, number of lymph node dissection in central area and number of lymph node metastasis in central area between group A and group B (all P>0.05). The drainage volume on the first day after operation [((51.7±26.7)) ml] and the average hospitalization days [(3.4±0.8) d] in group A were significantly lower than those in group B ([131.3±56.0)]ml,[10.4±2.6)]d). The differences were statistically significant (t value was -5.442,-11.238, respectively, both P<0.001). There were no significant differences in age, size of primary lesion, number of lymph node dissection, number of lymph node metastasis, drainage volume on the first day after operation and average hospitalization days between group B1 and group B2 (all P>0.05). All chyle leakages in group B stopped after conservative management without surgical intervention. Conclusion The occurrence of chyle leakage after central lymph node dissection is a rare complication. It can be cured by conservative treatment such as diet control, pressure bandaging and negative pressure drainage, and generally does not require secondary surgery.