甲状腺癌中央区淋巴结清扫术后并发乳糜漏临床诊治分析

目的:探讨甲状腺癌行中央区淋巴结清扫术后出现乳糜漏的原因、临床特点以及诊治方法。方法:回顾分析2015年8月至2019年8月西京医院甲乳血管外科行甲状腺癌中央区淋巴结清扫术后发生乳糜漏的9例患者的临床资料。结果:乳糜漏发生率为0.37%,出现在术后的第1～2天,中位时间1.2天;发生乳糜漏之前的引流量峰值为30～100 mL,中位数为85 mL;乳糜漏发生后,最大值为30～300 mL,中位数为75 mL。乳糜漏病人淋巴结清扫区域:左侧中央区清扫1例（11.1%）;右侧中央区清扫2例（22.2%）;双侧中央区清扫6例（66.7%）。淋巴结清扫数目8～27枚。发生乳糜漏后,6例经低脂或禁饮食、应用生长抑素或奥曲肽、持续低负压引流痊愈,3例经禁食、应用生长抑素、持续低负压引流效果不佳,经高负压引流、阶段退管等治疗后痊愈。乳糜漏基本治愈时间为3～15 d,中位时间5 d。结论:甲状腺癌中央区淋巴结清扫术后乳糜漏发生率较低,一般为轻中度,及时采取调整饮食或辅以持续低负压吸引可在短期内治愈,若低负压引流效果不佳,可采用高负压引流。     

持续强负压吸引联合静脉营养治疗甲状腺癌颈淋巴结清扫术后乳糜漏

目的探讨甲状腺癌颈淋巴结清扫术后发生颈部乳糜漏的机制及防治原则。方法15例甲状腺癌术后并发颈部乳糜漏的患者均采用持续强负压吸引（压力50-60 kPa,维持5-14天）,引流量〉200 ml/d的予以禁食并联合静脉营养及生长抑素治疗。结果13例经此保守方法治愈,未出现其它严重并发症;2例无效经再次手术结扎胸导管治愈。结论颈部乳糜漏的发生与其解剖密切相关,术中应仔细操作预防其损伤。持续强负压吸引联合静脉营养是治疗颈部乳糜漏的理想且安全的保守方法,少量乳糜漏保守治疗可痊愈,保守无效者尽早手术治疗。     

颈淋巴结清扫术后乳糜瘘的预防及处理

  目的 探讨颈清扫术后乳糜瘘的发生机制及预防处理原则。方法 河南省肿瘤医院头颈外科1983年1月至2005年1月共行各类颈清术1 750 例，出现乳糜瘘 48例、乳糜胸1例，发生率为2.8 ％，其中右侧5例，左侧44例；术前曾放、化疗者18例；治疗采用保守及手术两种方法，治疗中患者低脂饮食，保守治疗采用持续负压引流，局部加压包扎；日引流量超过500 ml经保守治疗效果不佳者手术治疗，手术采用结扎及局部喷涂创面封闭胶，带蒂肌肉瓣与创面粘合方法。结果 49例均获痊愈，保守治疗38例平均拔管时间为12.6（5～34）d；手术治疗11例平均拔管时间为7.5（3～10）d。结论 术中分别结扎胸导管及分支是主要预防措施，少量乳糜瘘保守治疗可痊愈，日引流量超过500 ml、保守治疗效果不佳者提倡尽早手术治疗，可缩短拔管时间。     

适形半球模体外压迫治疗颈清扫术后乳糜瘘

目的:评价应用适形半球模压迫锁骨上区治疗26例颈淋巴结清扫术后并发乳糜瘘患者疗效.方法:对我院因甲状腺癌接受颈清术后的26例患者临床资料进行回顾性分析.该组患者并发乳糜瘘并采用适形半球模具锁骨上区压迫法,且自身对照纱布敷料压迫法.结果:甲状腺癌颈清扫术后并发乳糜瘘发生率为2.31%,纱布敷料团局部加压有效率为30.00%,半球模具加压术区持续负压引流80.00%.结论:采用适形半球模具锁骨上压迫治疗颈清扫术后乳糜瘘方法简单,易操作,治疗周期短,疗效显著.可在临床上推广使用.     

强负压吸引治疗8例颈淋巴结清扫术后乳糜瘘

背景与目的颈部乳糜瘘是颈部手术后的并发症之一,其产生机制与其特定的解剖位置及变异密切相关,有关其治疗的意见仍有分歧。本文总结8例颈清扫术后并发乳糜瘘患者采用强负压吸引和饮食处理的临床经验,以评价其疗效。方法全部病例在确诊为乳糜瘘后立即采用强负压(-50～-30kPa)吸引,嘱禁食并给予合理的静脉营养。结果7例患者经此保守治疗痊愈,未出现其他严重并发症;1例无效,采用胸大肌肌瓣填塞。结论强负压吸引和合理的饮食处理有可能是颈清扫术后并发乳糜瘘早期处理较为理想且安全的保守疗法之一。     

颈清扫术后乳糜瘘和乳糜胸的诊断和治疗

目的：探讨颈清扫术后颈乳糜瘘及乳糜胸的发生原因、治疗方法。方法：34颈部乳糜瘘者采用颈部加压包扎＋负压引流,4例在保守治疗无效后,改为手术探查结扎瘘口或胸导管。2例乳糜胸行保守治疗,1例保守治疗无效开胸结扎胸导管。结果：34例颈部乳糜瘘采用颈部加压包扎＋负压引流后,30例痊愈,4例失败后经手术治疗痊愈,平均愈合时间10．2天（3-15天）。两例乳糜胸经保守治疗痊愈,1例保守治疗无效开胸结扎胸导管治愈。结论：颈部乳糜瘘和乳糜胸是少见的淋巴结清扫术后并发症,大多可以保守治疗治愈。     

颈清扫术后乳糜瘘和乳糜胸的诊断和治疗

目的:探讨颈清扫术后颈乳糜瘘及乳糜胸的发生原因、治疗方法.方法:34颈部乳糜瘘者采用颈部加压包扎+负压引流,4例在保守治疗无效后,改为手术探查结扎瘘口或胸导管.2例乳糜胸行保守治疗,1例保守治疗无效开胸结扎胸导管.结果:34例颈部乳糜瘘采用颈部加压包扎+负压引流后,30例痊愈,4例失败后经手术治疗痊愈,平均愈合时间10.2天(3-15天).两例乳糜胸经保守治疗痊愈,1例保守治疗无效开胸结扎胸导管治愈.结论: 颈部乳糜瘘和乳糜胸是少见的淋巴结清扫术后并发症,大多可以保守治疗治愈.     

喉癌颈淋巴结转移行颈清扫术后的疗效观察

目的:评估喉癌颈淋巴结转移行颈清扫术后的疗效.方法:统计分析我院1990年6月至2000年6月资料完整的喉癌病例356例,病理均为鳞状细胞癌,其中全喉切除73例,近全喉切除11例,喉部分切除256例,拒绝手术而接受放疗或放弃治疗16例(其中3例行气管切开术).术前颈部触诊、超声、CT、MR、细针穿刺及术中冰冻等方法确定转移淋巴结,同时或之后行颈淋巴清扫术共48例,其中N1 35例、N2 9例、N3 4例,术式:根治性颈清扫8例,改良根治性颈清扫13例(Ⅰ型1例、Ⅱ型4例、Ⅲ型9例,其中双侧清扫2例),选择性颈清扫27例(颈侧清扫17例, Ⅱ、Ⅲ区清扫10例 ),术后放疗60Gy5例,50Gy23例,40-46Gy8例, 12例未行放疗.结果:随访3年以上42例,随访5年35例.术后肿瘤原发部位复发3例,颈部复发6例(术侧5例,对侧1例) ,远处转移2例(肺和纵隔各1例),死亡5例(2年1例,3-5年4例).结论:根据肿瘤位置、范围及颈部淋巴结转移情况选择不同的颈清扫术式加术后放射治疗,虽然仍存在复发,但在减少创伤、预防颈清扫术的并发症和疗效等方面收到了较好的效果.     

甲状腺癌中央区淋巴结清除术后乳糜漏的防治

目的：探讨甲状腺癌中央区淋巴结清除术后乳糜漏发生的原因及有效的防治措施。方法：选取天津医科大学肿瘤医院2013年7 月至2015年6 月6 127 例甲状腺癌中央区淋巴结清除术病例,其中14例患者术后并发乳糜漏。采取全身治疗、局部加压包扎、常压引流、50% 葡萄糖注射液或平阳霉素经引流管注入等保守治疗,保守治疗效果不理想时行手术治疗。结果：12例患者行保守治疗后,引流量逐渐减少,至< 10mL/d时拔除引流管;2 例患者保守治疗后,引流量未见明显减少,行手术治疗。结论：甲状腺癌中央区淋巴结清除术时应仔细操作以预防乳糜漏的发生,发生后行保守治疗,保守治疗无效时行手术治疗。     

甲状腺癌颈廓清术后乳糜瘘的治疗体会

目的：甲状腺癌术中常规需要进行颈廓清术,术后会有乳糜瘘的发生,尽管发生率低,但后果严重。本研究总结治疗乳糜瘘的经验。方法：回顾分析近5年盛京医院普通外科262例因甲状腺乳头状癌行颈廓清手术的患者资料。以术后颈前引流液乳白色作为乳糜瘘判定标准,根据颈前引流量的情况及全身状况,分别采用不同的治疗方法,并对治疗效果进行评价。结果：共9例出现乳糜瘘,发生率3．4％。1例经过手术治疗痊愈,1例并发乳糜胸,经过胸腔穿刺治愈,其余7例均经过局部加压包扎,负压吸引,营养支持,积液穿刺治愈。结论：颈廓清术中应该熟悉解剖,仔细操作,以减少乳糜瘘发生。一旦并发乳糜瘘,多数可以采用保守方法治愈,只有保守治疗无效时才考虑手术治疗。     

颈部淋巴结清扫术后乳糜瘘的预防及处理

目的探讨颈部淋巴结清扫术乳糜瘘的发生、预防及处理原则。方法对1990～2002年收治的颈淋巴结清扫术病例516例，行颈侧清扫术528例(其中12例同期行双颈清扫术)进行分析，结果术后乳糜瘘发生率4．73％(25例)，右颈侧乳糜瘘发生率为3．5％(9／256)，左颈侧发生率为5．88％(16／272)。24例轻中度乳糜瘘经保守治疗治愈，1例重度乳糜瘘经保守治疗无效后再行手术治疗，采用右胸锁乳突肌下段肌瓣缝扎 碘仿纱条填塞治愈。结论术中结扎好胸导管或淋巴管破裂口是预防和避免乳糜瘘发生的关键措施之一；轻中度乳糜瘘采用保守疗法可治愈，术后不需禁食；对重度乳糜瘘经保守治疗无效后应采取手术治疗．     

Management of chylous fistula as a complication of neck dissection: a 10‐year retrospective review

SANTAOLALLA F., ANTA J.A., ZABALA A., DEL REY SANCHEZ A., MARTINEZ A. & SANCHEZ J.M. (2010) European Journal of Cancer Care
Management of chylous fistula as a complication of neck dissection: a 10‐year retrospective review Chylous fistula is a serious complication of neck surgery. The aim of this study was to analyse the incidence, treatment and evolution of chylous fistula in neck dissection. We conducted a retrospective study of 304 patients, 295 (97.03%) men and nine (2.97%) women. Ages ranged from 24 to 80 years (mean = 59.28 years, SD = 6.02) and they had all undergone neck dissection. Chylous fistula occurred in four cases (1.31%). Incidence was 1.83% in laryngeal cancer and 2.7% in oral cavity and oropharyngeal cancer. No statistically significant correlation was found between tumoral stage and fistula occurrence. Radiotherapy prior to surgery was a risk factor although the association was not statistically significant. The incidence rates for radical and functional neck dissection were 3.3% and 0.46%, respectively, statistically significant (P = 0.042). The fistulas were located on the left side in all cases. One of the four patients required surgical intervention and another one died. The occurrence of chylous fistula increased significantly the length of hospital stay (P = 0.01). Chylous fistulas appear on the left side, radiotherapy prior to surgery is a risk factor and there is not correlation with tumoral stage. Chylous fistulas are significantly more common in radical than in functional dissections and increase significantly the length of hospital stay.     

The role of selective neck dissection (I-III) in the treatment of node negative (N0) neck in oral cancer

It is now possible to limit the extent of selective neck dissection for mucosal squamous cell carcinoma of the head and neck by sparing selected lymphatic levels thereby reducing the morbidity. This has been brought about by our improved understanding of the metastasis behavior of these cancers. Studies have demonstrated similar rates of neck recurrences and survival after selective neck dissection compared to modified radical neck dissection. The purpose of this study was to evaluate the efficacy of selective neck dissection (SND) in managing the N0 neck in oral cavity carcinomas. A retrospective analysis of Squamous cell carcinoma of oral cavity with N0 neck from 1998 to 2004 was performed. Statistical analysis was done using SPSS software. The chi-square test was used to compare the various proportions. The overall and disease-free survival were estimated using the Kaplan–Meier method and statistical significant difference in survival was tested by log rank test. Out of the 219 cases, 84% were in the early stage and 16% were in the late stages. Seventy two percent of the patients had primary tumors in the anterior two-thirds of the tongue. One hundred and sixty one patients were pathologically node negative. There was no statistically significant difference in the regional recurrence between the pN0 and pN+ patients. There was no difference in the regional recurrence inside and outside the surgical field. The pathological node positive patients had a worse disease-free survival (DFS) compared to the node negative patients, and the patients with nodal recurrence had a significantly worse DFS compared to patients without nodal recurrence. SND (I–III) is a sound and effective procedure in the management of clinically negative neck in squamous cell carcinoma of the oral cavity. Clinically N0 neck but pathologically N+ neck requires adjuvant radiation therapy. It probably has a therapeutic role in the selected cases of squamous cell carcinoma of the oral cavity with N1 neck, and in these cases an extension of dissection to levels IV and V is beneficial.