橄榄油标记对甲状腺癌患者行甲状腺癌根治术和颈部淋巴结清扫术后乳糜漏的预防作用

Preventive effect of olive oil tracer on chylous leakage after radical thyroidectomy and radical neck dissection in patients with thyroid cancer

目的探讨甲状腺癌患者行甲状腺癌根治术和颈部淋巴结清扫术前口服橄榄油预防术后乳糜漏的效果。方法选择2013年1月至2019年12月河南省肿瘤医院收治的2627例甲状腺癌患者为研究对象,所有患者行甲状腺癌根治术和左侧颈部淋巴结清扫术,按术前是否口服橄榄油将患者分为观察组(n=1348)和对照组(n=1279)。观察组患者术前6 h口服橄榄油1 mL·kg-1,对照组患者术前未口服任何油剂或乳剂制剂。对2组患者术中胸导管辨识率、术后乳糜漏发生率及乳糜漏患者术后日最大引流量、总引流量及引流时间进行比较。结果所有患者均顺利完成手术,术中术后无死亡病例。观察组和对照组患者术中胸导管辨识率分别为91.17%(1229/1348)、65.36%(836/1279),观察组患者术中胸导管辨识率显著高于对照组(χ2=259.951,P<0.05)。观察组和对照组患者乳糜漏发生率分别为1.85%(25/1348)、3.44%(44/1279),观察组患者乳糜漏发生率显著低于对照组(χ2=6.451,P<0.05)。观察组乳糜漏患者日最大引流量和总引流量显著少于对照组,引流时间显著短于对照组(P<0.05)。结论甲状腺癌患者行甲状腺癌根治术和颈部淋巴结清扫术前口服橄榄油可以显著提高胸导管辨识率,降低乳糜漏发生率。

Objective To investigate the preventive effect of olive oil tracer on chylous leakage after radical thyroidectomy and radical neck dissection in patients with thyroid cancer.Methods A total of 2627 patients with thyroid cancer admitted to Henan Cancer Hospital from January 2013 to December 2019 were selected as the research subjects.All patients underwent radical thyroidectomy and left cervical lymphadenectomy and the patients were divided into observation group(n=1348)and control group(n=1279)according to whether they took olive oil before operation.The patients in the observation group took olive oil 1 mL·kg-1 at 6 hours before operation,while the patients in the control group did not take any oil or emulsion before operation.The identification rate of thoracic duct,the incidence of postoperative chylous leakage,the postoperative maximum daily drainage volume,total drainage volume and drainage time were compared between the two groups.Results The operations in all patients were successfully completed,and there was no death during and after the operation.The identification rate of thoracic duct in the observation group and the control group was 91.17%(1229/1348)and 65.36%(836/1279),respectively.The identification rate of thoracic duct in the observation group was significantly higher than that in the control group(χ2=259.951,P<0.05).The incidence of chylous leakage in the observation group and the control group was 1.85%(25/1348)and 3.44%(44/1279),respectively.The incidence of chylous leakage in the observation group was significantly lower than that in the control group(χ2=6.451,P<0.05).The maximum daily drainage volume and total drainage volume of chylous leakage patients in the observation group were significantly lower than that in the control group,and the drainage time in the observation group was significantly shorter than that in the control group(P<0.05).Conclusion Taking olive oil orally before radical thyroidectomy and radical neck dissection can significantly improve the identification rate of thoracic duct and reduce the incidence of chylous leakage.