中外健康文摘
中外健康文摘
중외건강문적
WORLD HEALTH DIGEST
2009年
18期
146-148
,共3页
甲状腺癌%颈淋巴结清扫术%淋巴管漏%乳糜瘘%治疗
甲狀腺癌%頸淋巴結清掃術%淋巴管漏%乳糜瘺%治療
갑상선암%경림파결청소술%림파관루%유미루%치료
Thyroid cancer Neck dissection Chyle leakage Management
目的 探讨甲状腺癌颈淋巴结清扫术后淋巴管漏和乳糜漏的原因,诊断及处理体会. 方法 回顾分析842例甲状腺癌行颈部淋巴结清扫术及术后发生淋巴管漏或乳糜漏的25例患者的临床病历资料. 结果 术中发现胸导管损伤5例,予结扎处理,术后未发生乳糜漏或淋巴瘘.术后发生淋巴管漏14 例,左侧4 例,右侧10例;发生胸导管漏11例;左侧10例,右侧1例.所有患者都给持续负压引流及局部压迫处理,部分患者给予饮食控制和肠外营养支持治疗.淋巴管漏的14例患者于1周内治愈,胸导管漏的 8例于2周内治愈,其余3例超过1月,最长1例45天治愈. 结论 术中恰当的处理可以有效避免术后淋巴管或胸导管漏的发生,术后一旦发现淋巴管漏或胸导管漏应及时给予持续负压引流,局部加压包扎和合理的饮食控制及及营养支持等保守治疗可获满意疗效.
目的 探討甲狀腺癌頸淋巴結清掃術後淋巴管漏和乳糜漏的原因,診斷及處理體會. 方法 迴顧分析842例甲狀腺癌行頸部淋巴結清掃術及術後髮生淋巴管漏或乳糜漏的25例患者的臨床病歷資料. 結果 術中髮現胸導管損傷5例,予結扎處理,術後未髮生乳糜漏或淋巴瘺.術後髮生淋巴管漏14 例,左側4 例,右側10例;髮生胸導管漏11例;左側10例,右側1例.所有患者都給持續負壓引流及跼部壓迫處理,部分患者給予飲食控製和腸外營養支持治療.淋巴管漏的14例患者于1週內治愈,胸導管漏的 8例于2週內治愈,其餘3例超過1月,最長1例45天治愈. 結論 術中恰噹的處理可以有效避免術後淋巴管或胸導管漏的髮生,術後一旦髮現淋巴管漏或胸導管漏應及時給予持續負壓引流,跼部加壓包扎和閤理的飲食控製及及營養支持等保守治療可穫滿意療效.
목적 탐토갑상선암경림파결청소술후림파관루화유미루적원인,진단급처리체회. 방법 회고분석842례갑상선암행경부림파결청소술급술후발생림파관루혹유미루적25례환자적림상병력자료. 결과 술중발현흉도관손상5례,여결찰처리,술후미발생유미루혹림파루.술후발생림파관루14 례,좌측4 례,우측10례;발생흉도관루11례;좌측10례,우측1례.소유환자도급지속부압인류급국부압박처리,부분환자급여음식공제화장외영양지지치료.림파관루적14례환자우1주내치유,흉도관루적 8례우2주내치유,기여3례초과1월,최장1례45천치유. 결론 술중흡당적처리가이유효피면술후림파관혹흉도관루적발생,술후일단발현림파관루혹흉도관루응급시급여지속부압인류,국부가압포찰화합리적음식공제급급영양지지등보수치료가획만의료효.
Objective To investigate the cause of lymphatic vessel leak and chyle leakage following neck dissection in papillary thyroid cancer patient. Methods 842cases were performed neck dissection, among them, 25 had post operative lymphatic vessel leak or chylous fistula were retro spectively analyzed. Results Intraoperative chyle leakage was observed in 5 patient, all on the left side and all controlled by suturing chyle fistula, thus avoiding post operative leakage. Lymphatic vessel leak occurred in 14 patients,10 in right, 4 in left; chylous fistula occurred in 11patients,10 in left,1in right. High negative pressure drainage and pressure dressing were applied in all patients, reasonable dietry control and perenteral nutrition support were applied in partial patients.Lymphatic vessel leak stopped in 14 patients within one week, 8 of chylous fistula stopped within 2 weeks, the other 3 stopped one month later. None of them underwent reoperation.Conclusion Postoperative lymphatic vessel leak or chylous fistula can be avioded by careful neck dissection in at-risk area duing operation. Proper postoperative conservative management is of great help when leakage occurred.
