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1、·2056·孫韶龍,等甲狀腺癌頸廓清術(shù)后乳糜瘺的治療體會?頭頸腫瘤?甲狀腺癌頸廓清術(shù)后乳糜瘺的治療體會111121孫韶龍,高峰,吳鑫,姚威,胡顯亮,王寶勝Thetreatmentexperienceofchylousfistulafollowingneckdissectionforthyroidcarcinoma111121SunShaolong,GaoFeng,WuXin,YaoWei,HuXianliang,WangBaosheng12DepartmentofGeneralSurgery,ShengjingHospitalofChinaMedicalUnivers
2、ity,LiaoningShenyang110004,China;The3rdPeople'sHospitalofLiaoyang,LiaoningLiaoyang111000,China.【Abstract】Objective:Chylousfistulamayoccurafterradicalneckdissectionfortreatingthyroidcarcinoma,whichoccurredrarely,butmaybeserous.Wewillsummarizetheexperienceoftreatingchylousfistula.Methods:
3、Weretrospectivelyanalyzed262casesofneckdissectionforthyroidpapillarycarcinomainShengjingHospital.Thecolorandvolumeofneckdrainagefluidwasdetected.Ifthecolorismilkywhite,wedefineitaschylousfistula.Basedontheneckdrainageconditionandgeneralstatus,weemployeddifferenttreatmentmethod.Results:
4、Therewas9casesofchylousfistula,themorbiditywas3.4%.1casewasrecurredbyoperation,onechylothoraxoccurredandrecoveriedbythoraxcavitypuncture.Therest7caseswerecuredbyconservativetreatment,suchascompressivedress,closedvacuumdrainage,nutritionsupport,injectionofsomatostatinanalogandpunctureof
5、accumulatedfluid.Conclusion:Inordertodecreasethemorbidityofchylousfistula,allthesurgicalprocedureinneckdissectionshouldbemeticulous.Oncechylousfistulaoccurred,mostcasescanbecuredbyconservativetreatment,andneckreoperationshouldrepresentthelasttherapeuticoption.【Keywords】neckdissection;
6、thyroidcarcinoma;chylousfistulaModernOncology2014,22(09):2056-2057【摘要】目的:甲狀腺癌術(shù)中常規(guī)需要進(jìn)行頸廓清術(shù),術(shù)后會有乳糜瘺的發(fā)生,盡管發(fā)生率低,但后果嚴(yán)重。本研究總結(jié)治療乳糜瘺的經(jīng)驗(yàn)。方法:回顧分析近5年盛京醫(yī)院普通外科262例因甲狀腺乳頭狀癌行頸廓清手術(shù)的患者資料。以術(shù)后頸前引流液乳白色作為乳糜瘺判定標(biāo)準(zhǔn),根據(jù)頸前引流量的情況及全身狀況,分別采用不同的治療方法,并對治療效果進(jìn)行評價。結(jié)果:共9例出現(xiàn)乳糜瘺,發(fā)生率3.4%。1例經(jīng)過手術(shù)治療痊愈,1例并發(fā)乳糜胸,經(jīng)過胸腔穿刺治愈,其余7例均經(jīng)過局部
7、加壓包扎,負(fù)壓吸引,營養(yǎng)支持,積液穿刺治愈。結(jié)論:頸廓清術(shù)中應(yīng)該熟悉解剖,仔細(xì)操作,以減少乳糜瘺發(fā)生。一旦并發(fā)乳糜瘺,多數(shù)可以采用保守方法治愈,只有保守治療無效時才考慮手術(shù)治療?!娟P(guān)鍵詞】頸廓清;甲狀腺癌;乳糜瘺【中圖分類號】R736.1【文獻(xiàn)標(biāo)識碼】ADOI:10.3969/j.issn.1672-4992.2014.09.15【文章編號】1672-4992-(2014)09-2056-02甲狀腺乳頭狀癌占甲狀腺癌總數(shù)的70%和兒童甲狀腺術(shù)后乳糜瘺患者的臨床資料,旨在總結(jié)預(yù)防和治療乳糜瘺的癌的全部,盡管預(yù)后較好,但是呈多中心性傾向,較早出現(xiàn)頸經(jīng)驗(yàn)。