颈部淋巴清扫术后严重淋巴漏的非手术治疗体会

目的 探讨非手术综合治疗措施在甲状腺癌颈部清扫术后严重淋巴漏防治中的应用价值。方法 回顾性分析两例颈部淋巴结清扫术后严重淋巴漏患者的临床资料和治疗过程,结合国内外文献对严重颈部淋巴漏的防治方法进行探讨。结果 通过饮食控制、营养支持、局部加压包扎、负压引流、生长抑素、以及高浓度复方泛影葡胺注射液局部注射等非手术治疗综合措施,可促进颈部淋巴结清扫术后严重淋巴漏患者的愈合。结论 饮食控制、营养支持、局部加压包扎、负压引流、生长抑素、以及高浓度复方泛影葡胺注射液局部注射等非手术治疗综合措施,在甲状腺癌颈部淋巴结清扫术后严重淋巴漏的防治中是安全有效的,可作为首选。     

铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后淋巴漏的临床分析

目的探讨铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后淋巴漏的方法及效果。方法笔者所在医院2012年4月至2012年7月期间共治疗甲状腺癌颈部淋巴结清扫术后顽固性淋巴漏患者4例,均采用铜绿假单胞菌注射液治疗。将铜绿假单胞菌注射液（1 mL或2 mL）通过引流管逆行注射到创腔,夹闭引流管1 h后再开放引流管。结果 4例患者注射前1 d 24 h引流量分别为200、350、540及810 mL,其中2例患者为乳糜漏,引流时间分别为7 d和15 d;另2例患者为单纯淋巴漏,引流时间分别为13 d和14 d。注射1 d后,引流量分别减少至20、45、120及255 mL,4 d后4例患者均顺利拔除引流管。4例患者治疗后均有不同程度的发热,经物理降温后体温恢复;均有不同程度的局部疼痛感,3例患者疼痛能耐受,另1例疼痛剧烈患者予以美洛昔康口服后缓解。结论铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后顽固性淋巴漏的疗效显著。     

分化型甲状腺癌颈淋巴结清扫术后淋巴漏治疗体会

<正>分化型甲状腺癌(DTC)术中行颈淋巴结清扫可降低肿瘤的复发率和病死率,但术后可能发生淋巴漏[1-2]。本研究总结笔者医院2008-2014年行甲状腺全切除+颈淋巴结清扫术病例,对术后淋巴漏发生及治疗情况进行分析。现报告如下。1临床资料1.1一般资料共纳入行甲状腺全切除+颈淋巴结清扫术病人234例,其中男性82例,女性152例,年龄46.8(16~79)岁。淋巴漏的发生界定为术后第2天引流量明显术后     

颈部淋巴结清扫术后淋巴漏的观察和护理

目的探讨颈部淋巴结清扫术后并发淋巴漏的观察和有效的护理措施。方法对18例颈淋巴结清扫术后并发淋巴漏患者的治疗和护理措施进行总结。结果 653例行颈淋巴结清扫患者发生淋巴漏18例,占2.75%,经术后严密观察切口引流情况,采取持续恒定的负压吸引、控制饮食、补充营养、应用奥曲肽等有效的医疗护理措施,18例淋巴漏均顺利愈合,无感染发生。结论有针对性的护理有助于颈淋巴结清扫术后并发淋巴漏患者的康复。     

颈部淋巴结清扫术后乳糜漏治疗体会

颈部淋巴结清扫术后乳糜漏是临床较为少见的严重并发症,如不及时恰当处理,可继发局部感染、切口不愈合、淋巴细胞减少、免疫功能降低、循环血量减少,导致电解质紊乱、低蛋白血症甚至患者死亡.1994年2月至2012年3月,我们在行颈部淋巴结清扫术后发生乳糜漏7例,现报告如下.     

高渗糖局部注射治疗甲状腺癌颈部淋巴结清扫术后淋巴漏疗效分析

目的 探讨高渗糖局部注射用于甲状腺癌术后淋巴漏病人的疗效。方法 回顾性分析郑州大学第一附属医院甲状腺外一科2017年2月至2018年12月术后出现难治性淋巴漏并行高渗糖注射的9例病人资料。结果 9例病人中，8例应用高渗糖后引流液持续减少并最终拔管，3例首次应用且引流液下降50%以上，4例病人连续注射2 d高渗糖后引流液下降50%以上，1例病人经注射高渗糖无效后，行二次手术结扎，并最终拔管。结论 对于甲状腺癌术后合并难治性淋巴漏病人，采用高渗糖局部注射治疗，可促进创面愈合，减少病人痛苦。     

专利蓝示踪预防腹股沟淋巴结清扫术后淋巴漏的体会

腹股沟淋巴结清扫术后的常见并发症之一是淋巴漏。淋巴漏导致皮下积液,因而影响伤口的愈合甚至导致伤口感染。在临床上尽管采用了许多方法,比如加压包扎、加强引流等方法,其效果仍不甚明显。我们受文献[1]介绍的前哨淋巴结活检方法的启示,对8例行腹股沟淋巴结清扫术的病人,在清     

胃癌根治术后腹腔淋巴漏的诊治体会

目的探讨胃癌根治术后腹腔淋巴漏发生的原因及防治。方法对我院1998年1月至2008年6月行胃癌根治手术的756例患者的临床资料进行回顾性分析并总结。结果756例胃癌根治术后发生腹腔淋巴漏8例,占1.058%(8/756)。发生时间为术后3~7 d,引流量为200~1000 ml/d,引流时间8~40 d,经非手术治疗后均治愈。结论术前充分准备,改善患者全身状态,术中选择合适的手术范围,提高手术技巧,可以减少术后腹腔淋巴漏的发生。术后一旦出现淋巴漏,保守疗法均可治愈。     

腹股沟淋巴结清扫术后淋巴漏的危险因素和治疗策略分析

目的探讨腹股沟淋巴结清扫手术后淋巴漏的危险因素和治疗策略。方法本研究共纳入56例在我院行腹股沟淋巴结清扫手术的阴茎癌患者。清扫手术的范围以腹股沟韧带上2cm为上界,缝匠肌内侧缘为外侧界,长收肌外侧缘为内侧界,股三角尖端为下界,清除该范围内的淋巴脂肪组织。淋巴漏在本研究中的定义:自术后第3天起,引流管引流>100ml的淡黄色液体,连续2d。采用Logistic多因素回归分析找出淋巴漏的独立危险因素。结果 56例阴茎癌患者的中位年龄为51岁,腹股沟清扫区平均每天引流量为63.65ml,而淋巴漏的发生率为36.0%(40/111),同时多因素分析结果显示,体重指数是淋巴漏的独立危险因素,OR值为1.03。经过适当处理后,出现淋巴漏的腹股沟伤口区的置管时间均<4周。结论腹股沟淋巴结清扫术后淋巴漏的发生率较高,但术中对淋巴组织残端进行充分结扎,同时术后给予适当的治疗能减少淋巴漏的发生。     

肝胆术后胆漏的非手术治疗

目的探讨运用无创和微创治疗胆漏的方法。方法对近5年来31例肝胆术后胆漏非手术治疗的临床资料进行回顾性分析。本组31例均采用非手术治疗。结果除1例带管出院、1例晚期胆管癌自动出院外，其余均痊愈出院，总治愈率93．5％(29／31)。结论在做好再手术准备的前提下，肝胆术后胆漏可选择无创和微创治疗。     

非手术治疗重症急性胰腺炎

20世纪90年代以来,重症急性胰腺炎(severeacute pancreatitis,SAP)的治疗已逐渐达成共识,在病程早期采取积极的非手术治疗,在病程后期当继发胰腺感染时,需手术治疗[1].     

Shoulder function after accessory nerve-sparing neck dissections

BACKGROUND: This study was designed to observe the effect of preserving the spinal accessory nerve (SAN) during neck dissection (ND) and adjuvant radiotherapy (ART) after ND on shoulder function. METHODS: Fifty-seven patients with head and neck cancer who had undergone primary tumor resection and various types of NDs were enrolled in this prospective study. Postoperative shoulder joint range of motion was evaluated by goniometry, and muscle strength was measured manually. SAN function was evaluated with electromyography (EMG) with respect to percentage of denervation and presence of neurogenic involvement. Patients were grouped by treatment as follows: radical ND (RND) versus modified radical ND (MRND)/selective ND (SND) and ART versus no ART. RESULTS: Shoulder joint range of motion and shoulder muscle strength were significantly better in the MRND/SND group than in the RND group. However, EMG findings were similar in the RND and MRND/SND groups. When all patients who underwent ND, RND, or MRND/SND were compared with the control group, statistically significant changes in shoulder joint range of motion and shoulder muscle strength were found. Also, denervation and neurogenic involvement of the SAN were significantly higher after all NDs than in the control group. ART did not affect range of motion of the shoulder joint, shoulder muscle strength, or the degree of denervation and neurogenic involvement in any of the ND groups. CONCLUSIONS: ART does not have a negative effect on shoulder function after ND. SAN is always functionally impaired even if we preserve it macroscopically during ND.     

Value of contralateral supraomohyoid neck dissections

This study was carried out to determine the merit of contralateral supraomohyoid neck dissection in the clinically negative neck. When performed in conjunction with a standard radical neck dissection on the ipsilateral side, a yield of 2.8 percent pathologically positive nodes (5 of 177) was obtained in the contralateral neck. Little difference was noted in the yield of midline lesions versus unilateral lesions which approached the midline (3 and 2.6 percent, respectively). Similarly, the yield with preoperative radiation was close to that of the nonradiated group (3 and 2.7 percent, respectively). Additionally, in 1.7 percent of patients (3 of 177) with both clinically and pathologically negative nodes, metastases later developed in the contralateral neck, which indicates that the dissection is not necessarily effective in preventing future disease. The contralateral supraomohyoid neck dissection in the treatment of malignancies of the oral cavity, pharynx, and larynx does not appear to be of significant therapeutic value.     

腰大池引流治疗颈椎肿瘤术后脑脊液漏

目的分析持续腰大池引流治疗颈椎肿瘤术后脑脊液漏的临床效果。方法回顾性分析第二军医大学附属长征医骨肿瘤科2013年7月—2015年12月收治的接受颈椎肿瘤手术的264例患者资料(术后转至上海开元骨科医院继续治疗),其中颈椎肿瘤术后发生脑脊液漏并行持续腰大池引流的患者47例。24例患者因积极一般治疗后症状无明显缓解、13例伤口渗液明显、2例疑似合并颅内感染、8例2周的一般治疗后引流量仍较大而分别选择行腰大池引流。记录置管时间及引流时间,观察伤口愈合情况。结果所有患者经持续腰大池引流治疗后均获痊愈。持续引流7~43 d,平均13.8 d,腰大池置管时间为1~19 d,平均7.1 d。随访中有2例出现脑脊液囊肿,给予患者局部穿刺引流并局部加压包扎后治愈,其余无严重并发症。结论颈椎肿瘤术后脑脊液漏患者行持续腰大池引流治疗能有效控制患者不适症状,有助于伤口愈合,可预防和治疗颅内感染等,疗效确切。     

Noninterventional treatment of selected head and neck lymphatic malformations

Background

Indications for treatment of lymphatic malformations include disfigurement, symptoms, and infection. Patients with lymphatic malformations often undergo resection or sclerotherapy to prevent possible complications, as it has been thought that lymphatic lesions do not regress.

Methods

A retrospective analysis of all head and neck lymphatic malformations for the past 5 years was performed.

Results

Twenty-five patients with lymphatic malformations of the head and neck were treated, all underwent computed tomography or magnetic resonance imaging for evaluation. Fourteen patients had macrocystic lesions; others were considered mixed or microcystic. Seventeen patients underwent intervention. Ten patients underwent surgical resection alone, 4 patients underwent sclerotherapy, and 3 patients had both sclerotherapy and surgical resection. Of 17, 15 patients who underwent intervention had complications, including recurrence and nerve damage. Eight patients with predominantly macrocystic lesions were managed with close observation and were asymptomatic other than a mass. With follow-up of 33.4 months, in 4 of 8 patients, the lesion significantly decreased; 4 of 8 patients continue to be asymptomatic.

Conclusions

Patients who undergo intervention have a high complication and recurrence rate. Selected patients with asymptomatic macrocystic lymphatic malformations of the head and neck can often be managed by observation alone. These patients should be followed closely in a multidiscliplinary clinical setting.