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中华普外科手术学杂志(电子版) ›› 2026, Vol. 20 ›› Issue (01) : 87 -90. doi: 10.3877/cma.j.issn.1674-3946.2026.01.024

综述

甲状腺癌颈部淋巴结清扫术后乳糜漏的预防与治疗措施
刘楷, 代文杰()   
  1. 150001 哈尔滨,哈尔滨医科大学附属第一医院甲状腺外科
  • 收稿日期:2025-05-27 出版日期:2026-02-26
  • 通信作者: 代文杰

Prevention and treatment measures for chylous fistula after cervical lymph node dissection for thyroid cancer

Kai Liu, Wenjie Dai()   

  1. Department of Thyroid Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin Liaoning Province 150001, China
  • Received:2025-05-27 Published:2026-02-26
  • Corresponding author: Wenjie Dai
  • Supported by:
    Chen Xiao-Ping Foundation For The Development of Science And Technology of Hubei Province(CXPJJH12000002-2020023); Scientific Research Project of the Health Commission of Heilongjiang Province(20210303041142)
引用本文:

刘楷, 代文杰. 甲状腺癌颈部淋巴结清扫术后乳糜漏的预防与治疗措施[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(01): 87-90.

Kai Liu, Wenjie Dai. Prevention and treatment measures for chylous fistula after cervical lymph node dissection for thyroid cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(01): 87-90.

随着甲状腺癌伴颈部淋巴结转移发生率的升高,颈部淋巴结清扫术已成为治疗此类疾病的主要手段。然而,颈部淋巴管网错综复杂,术中易损伤淋巴管,导致术后乳糜漏。这不仅影响患者预后,还会增加其心理负担。目前,国内外乳糜漏的防治措施多样,但操作复杂且缺乏明确的适应证指导临床选择。本文旨在综述减少颈部淋巴结清扫术后引流量及降低乳糜漏发生率的相关措施。

With the increasing incidence of thyroid cancer complicated by cervical lymph node metastasis, cervical lymph node dissection has become a primary treatment for such diseases. However, the cervical lymphatic network is intricate and complex, making intraoperative injury to lymphatic vessels likely, which leads to postoperative chylous fistula. This not only affects the patient's prognosis but also increases their psychological burden. Currently, there are various preventive and therapeutic measures for chylous fistula at home and abroad, yet these measures are complex to operate and lack clear indications to guide clinical selection. This article aims to review the relevant measures for reducing the drainage volume after cervical lymph node dissection and lowering the incidence of chylous fistula.

[1]
付利军, 孔玉静, 贺奇, 等. 铜绿假单胞菌注射液治疗甲状腺乳头状癌颈侧区淋巴结清扫术后乳糜漏的临床观察[J]. 中国普通外科杂志, 2021, 30(11): 1343-1349.
[2]
王庆艳, 王慧慧, 刘丽亚. 甲状腺癌颈淋巴结清扫术后难治性乳糜漏的临床分析[J]. 实用癌症杂志, 2023, 38(04): 661-663, 667.
[3]
李武, 李慧, 周诗韦, 等. 经口入路腔镜甲状腺癌侧颈淋巴结清扫手术后淋巴漏的防治:附47例报道[J]. 中国普外基础与临床杂志, 2024, 31(11): 1324-1329.
[4]
Park I, Her N, Choe JH, et al. Management of chyle leakage after thyroidectomy, cervical lymph node dissection, in patients with thyroid cancer [J]. Head Neck, 2018, 40(1): 7-15.
[5]
贺青卿, 田文, 朱精强, 等. 甲状腺癌颈淋巴结清扫术后乳糜漏防治中国专家共识(2022版)[J]. 中国实用外科杂志, 2022, 42(06): 616-620.
[6]
陈兴, 张爱龙, 游振辉. 甲状腺癌颈部淋巴结改良清扫术后乳糜漏的影响因素分析[J]. 福建医药杂志, 2020, 42(01): 44-46.
[7]
代立媛, 吴俊福, 张旭, 等. 橄榄油标记对甲状腺癌患者行甲状腺癌根治术和颈部淋巴结清扫术后乳糜漏的预防作用[J]. 新乡医学院学报, 2021, 38(04): 345-348.
[8]
王刚, 于芳, 范子义, 等. 甲状腺癌颈淋巴结清扫术后难治性乳糜漏临床分析[J]. 中国普外基础与临床杂志, 2022, 29(04): 517-521.
[9]
高洋, 崔建春, 费翔, 等. 颈托在治疗甲状腺癌术后乳糜漏中的应用[J]. 中国临床研究, 2021, 34(10): 1366-1369.
[10]
Molena E, King E, Davies-Husband C. Octreotide versus oral dietamodification for the treatment of chylous fistula following neck dissection: A systematic review and meta-analysis[J]. Clin Otolaryngol, 2021, 46(3): 474-484.
[11]
Baloch ZW, Asa SL, B arletta JA, et al. Overview of the 2022 WHO Classification of Thyroid Neoplasms [J]. Endocr Pathol, 2022, 33(1): 27-63.
[12]
郭南南, 姚樟燠, 琚国园, 等. 金丹附延颗粒治疗甲状腺癌侧颈淋巴结清扫术后难治性乳糜漏的疗效(附3例报道)[J]. 中国普外基础与临床杂志, 2024, 31(11): 1319-1323.
[13]
Zhang M, Luo F, Zhang Y, et al. Pseudomonas aeruginosa mannose-sensitive hemagglutinin promotes T-cell response via toll-like receptor 4-mediated dendritic cells to slow tumor progression in mice [J]. Pharmacol Exp Ther, 2014, 349(2): 279-87.
[14]
陆彦伶, 吴晖. 铜绿假单胞菌注射液超说明书用药的合理性探讨及案例分析[J]. 中国现代应用药学, 2020, 37(13): 1638-1641.
[15]
董哲, 高成生. 铜绿假单胞菌注射液对结肠部分切除大鼠免疫系统影响的研究[J]. 中国现代医学杂志, 2011, 21(33): 4132-4134, 4140.
[16]
马宇, 曾翠芳, 邹秀和, 等. 甲状腺全切及双侧中央区淋巴结清扫后创腔运用铜绿假单胞菌注射液局部喷洒对喉返神经的影响[J]. 中国普外基础与临床杂志, 2020, 27(12): 1496-1500.
[17]
Agrawal A, Chaddha U, Kaul V, et al. Multidisciplinary Management of Chylothorax [J]. Chest, 2022, 162(6): 1402-1412.
[18]
Liu H, Liu L, Yang X. Chylous fistula after right breast fibroadenoma resection: a case report [J]. Front Surg, 2024, 10: 1269301.
[19]
Parmeggiani D, Gualtieri G, Terracciano G, et al. Prolonged iatrogenic thoracic duct chylous fistula in neck surgery: conservative management or surgery? A literature review [J]. Scand J Surg, 2021, 110(4): 550-556.
[20]
Acosta-Mérida MA, Cano-Contreras L, Brito-Pérez Z, et al. Iatrogenic chylous fistula after total thyroidectomy for papillary thyroid cancer [J]. Cir Esp (Engl Ed), 2023, 101(9): 644.
[21]
Ríos A, rodríguez JM, Torregrosa NM, et al. Chyle fistula as complication of thyroid surgery in malignant pathology [J]. Endo crinol Diabetes Nutr, 2019, 66(4): 247-253.
[22]
Campisi CC, Boccardo F, Piazza C, et al. Evolution of chylous fistula management after neck dissection [J]. Curr Opin Otolaryngol Head Neck Surg, 2013, 21(2): 150-156.
[23]
Abe T, Kawai R, Uemura N, et al. Chylous leakage from a remaining duplicated left-sided thoracic duct after esophagectomy successfully treated by ligation of the left-sided thoracic duct with left-sided video-assisted thoracoscopic surgery with the patient in the prone position [J]. Asian J Endosc Surg, 2016, 9(2): 138-141.
[24]
Bhangu JS, Bichler C, Altmeier J, et al. Papillary thyroid cancer: the value of bilateral diagnostic lymphadenectomy [J]. Langenbecks Arch Surg, 2022, 407(5): 2059-2066.
[25]
林孝文, 张再重, 王烈. 甲状腺癌颈清术后乳糜漏的诊治现状[J/CD]. 中华普外科手术学杂志(电子版), 2015, 19(01): 70-71.
[26]
Lambertz R, Chang DH, Hickethier T, et al. Ultrasound-guided lymphangiography andinterventional embolization of chylous leaks following esophagectomy [J]. Innov Surg Sci, 2019, 4(3): 85-90.
[27]
Hunt JP, Wilson M, Buchmann LO. Chylothorax associated with substernal goiter treated with transcervical thyroidectomy [J]. Thyroid, 2011, 21(5): 551-553.
[28]
李永康, 王南鹏, 杨能红. 左颈清术后合并双侧乳糜胸及肺炎一例[J]. 临床外科杂志, 2020, 28(06): 598.
[29]
Ronsini C, Iavarone I, Braca E, et al. The Efficiency of Sclerotherapy for the Management of Endometrioma: A Systematic Review and Meta-Analysis of Clinical and FertilityOutcomes [J]. Medicina (Kaunas), 2023, 59(9): 1643.
[30]
孙团起. 甲状腺手术后颈部乳糜漏的预防及处理[J]. 中国实用外科杂志, 2018, 38(06): 628-630.
[31]
许海涛. 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分析[J]. 中国医药指南, 2017, 15(05): 127-128.
[32]
袁芊芊, 李承欣, 邢明照, 等. 胸导管显微修补术及结扎术在甲状腺癌术中处理胸导管损伤的临床疗效分析[J]. 中华内分泌外科杂志, 2023, 17(04): 390-393.
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