介入手术治疗甲状腺癌颈淋巴结清扫术后难治性淋巴漏临床分析

Interventional surgery for refractory lymphatic leakage after radical neck dissection in thyroid cancer

目的对比分析开放、腔镜和介入治疗甲状腺癌颈淋巴结清扫术后难治性淋巴漏的治疗效果,探索介入治疗难治性淋巴漏的可行性。方法回顾性分析2018年1月至2023年12月郑州大学第一附属医院甲状腺外科甲状腺癌颈淋巴结清扫术后难治性淋巴漏行手术治疗患者41例,根据手术方式进行分组,其中开放组18例、介入组14例和腔镜组9例。对比分析不同手术方式对甲状腺癌颈淋巴结清扫术后难治性淋巴漏的效果,观察术后第1、3、5天引流量、拔管时间、住院时间和费用。组间对比采用方差分析和独立样本Kruskal-Wallis检验。结果开放、腔镜和介入三种方式治疗甲状腺癌颈淋巴结清扫术后难治性淋巴漏均好转,术后第1、3和5天引流量分别为(96.67±46.40)、(64.44±30.46)、(72.86±57.70)mL(P=0.197),(43.89±25.70)、(33.33±12.25)、(39.29±36.68)mL(P=0.653)和(22.50±19.42)、(16.67±15.61)、(20.00±27.39)mL(P=0.806),差异均无统计学意义。开放手术花费为(0.33±0.75)万元,低于腔镜组的(0.56±0.70)和介入组的(0.76±0.84)万元(F=126.245,P<0.001);介入手术住院时间为(2.36±0.50)d,低于开放组的(4.67±1.14)和介入组的(4.56±1.13)d(P<0.001)。结论介入治疗可用于治疗甲状腺癌颈淋巴结清扫术后难治性淋巴漏。

ObjectiveTo compare and analyze the therapeutic effects of open,laparoscopic and interventional treatments for refractory lymphatic leakage after radical neck dissection in thyroid cancer,and the feasibility of interventional treatment for refractory lymphatic leakage.MethodsTotally 41 patients with refractory lymphatic leakage after radical neck dissection in thyroid cancer at thyroid surgery department of First Affiliated Hospital of Zhengzhou University from Jan.2018 to Dec.2023 were retrospectively enrolled.They were divided into open surgery group(n=18),interventional surgery(n=14),and laparoscopic surgery group(n=9)based on surgical methods.The drainage volume,extubation time,hospital stay,and cost on the 1st,3rd,and 5th day after surgery were recorded.Inter group comparison was conducted using analysis of variance and independent sample Kruskal-Wallis test.The effects of different groups on incurable lymphatic leakage after radical neck dissection in thyroid cancer were compared and analyzed.ResultsThe treatment of refractory lymphatic leakage after radical neck dissection in thyroid cancer using open,endoscopic,and interventional methods all improved.On the 1st,3rd and 5th day after surgery,the drainage volumes were(96.67±46.40)mL,(64.44±30.46)mL,(72.86±57.70)mL,P=0.197,(43.89±25.70)mL,(33.33±12.25)mL,(39.29±36.68)mL,P=0.653,and(22.50±19.42)mL,(16.67±15.61)mL,(20.00±27.39)mL,P=0.806,respectively,and the differences were not statistically significant.The cost of open surgery was lower than that of the other groups(0.33±0.75 vs 0.56±0.70,0.76±0.84,F=126.245,P<0.01)and postoperative hospital stay for interventional surgery was lower than the other groups[(2.36±0.50)d vs(4.67±1.14)d,(4.56±1.13)d,P<0.01].ConclusionInterventional therapy could be used to treat incurable lymphatic leakage after radical neck dissection in thyroid cancer.