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目的总结甲状腺癌联合根治术后乳糜瘘的治疗效果。方法回顾性分析我院1992~2010年18例甲状腺癌联合根治术后乳糜瘘的临床资料。18例中,乳糜瘘发生在左侧15例,右侧3例。13例采用负压吸引、局部加压、低脂饮食或同时给予皮瓣下注入50%葡萄糖的保守治疗;5例接受手术治疗。结果 18例中,15例(83.3%)的乳糜瘘发生于手术后的最初3 d。13例保守治疗结果:8例获得痊愈,愈合时间为4~30 d,中位时间9.7 d;5例失败,经手术治疗而痊愈,愈合时间为2~37 d,中位时间15.4 d。结论甲状腺癌联合根治术后的乳糜瘘经合理地治疗是可以治愈的,并不延长患者的住院时间。对乳糜量每日少于500 ml的早期乳糜瘘可采用保守治疗;对保守治疗短期内无效及乳糜量每日超过500 ml的患者,应及时采用手术治疗。
Objective To summarize the therapeutic effect of chylothoracic fistula after radical thyroidectomy. Methods The clinical data of 18 cases of thyroid carcinoma combined with radical mastectomy for chylous fistula in our hospital from 1992 to 2010 were retrospectively analyzed. In 18 cases, chylous fistula occurred in the left side in 15 cases and in the right side in 3 cases. Thirteen patients were treated with negative pressure, local pressure, low-fat diet or conservative treatment with 50% glucose injection under the flap. Five patients underwent surgery. Results In 18 cases, 15 cases (83.3%) of chylous fistula occurred in the first 3 days after operation. Among the 13 cases, conservative treatment resulted in complete recovery in 8 cases. The healing time ranged from 4 to 30 days and the median time was 9.7 days. Five cases failed and healed by surgery. The healing time was 2 to 37 days and the median time was 15.4 days. Conclusion Thyroid cancer combined with radical mastectomy after the rational treatment of chylous fistula can be cured, does not extend the patient’s hospital stay. Conservative treatment of early chyle fistula with an amount of less than 500 ml per day can be used conservatively. Surgical treatment should be performed promptly for those patients who are ineffective in conservative treatment and have an excess of 500 ml of celiac daily.