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目的探讨甲状腺癌颈淋巴结清扫术后并发乳糜漏的治疗方法及效果。方法甲状腺癌颈淋巴结清扫术后并发乳糜漏患者20例,17例24h引流量≤100mL,给予控制脂类食物摄入,负压吸引及左锁骨加压包扎等保守治疗;3例24h引流量>100mL,再次手术治疗,术中对漏口较窄者进行缝扎治疗,对漏口较大者将患者肩胛舌骨肌肩胛端切断、填塞周围组织后再进行缝合;术后漏口周围喷洒生物蛋白胶。随访观察治疗效果。结果17例保守治疗6~12(8.9±1.7)d,漏口顺利痊愈;3例再次手术治疗后10~13(12.1±0.7)d漏口愈合;治疗后随访1个月,1例失访,余19例均未出现乳糜漏复发或颈部肿胀,甲状腺功能复查未见异常。结论对甲状腺癌颈淋巴结清扫术后并发乳糜漏患者,可根据24h引流量采取保守或手术治疗措施,有效促使漏口愈合。
Objective To investigate the treatment and effect of chylothorax after cervical lymph node dissection of thyroid cancer. Methods Twenty patients with thyroid cancer who underwent cervical lymph node dissection were included in this study. Twenty cases of patients with chyle leakage were included in this study. Twenty-seven patients underwent drainage for less than or equal to 100 mL for 24 hours. Controlled the intake of lipids, negative pressure and conservative treatment of left subclavian compression banding, 100mL, again surgical treatment of intraoperative leakage of narrower who suture treatment, the greater the leakage of the patient scapulae scapular shunt, cut off the surrounding tissue and then suture; Protein glue. Follow-up observation of the therapeutic effect. Results 17 cases were treated conservatively for 6-12 days (8.9 ± 1.7 days), and the leakage was cured. Three cases were healed after 10-13 (12.1 ± 0.7) days of reoperation. The patients were followed up for 1 month and 1 case lost to follow-up , No recurrence of chyle leakage or swelling of the neck in the remaining 19 cases, no abnormal thyroid function examination. Conclusions Patients with congenital lymph node dissection after thyroidectomy with chylothorax may be treated conservatively or surgically according to the 24-hour drainage volume, which effectively promotes the healing of the leakage.