Sharing Experience in the Treatment of Chylous Leakage in Thyroid Cancer Radical Resection and Central Lymph Node Dissection Patients

摘要

Objective: The Purpose of this article was to share experience in the treatment of postoperative chylous leakage in thyroid cancer radical resection and central lymph node dissection patients, and provide a reference for clinicians. Method: A retrospective analysis 5145 cases of patients information from October 2009 to October 2015 whom underwent thyroid radical resection and central lymph node dissection for thyroid cancer in Department of Thyroid Surgery, The First Hospital of Jilin University. Intraoperative findings, chylous fluid drainage volume, the general state of the patient before and after chylous leakage (including body weight, serum albumin, ion levels), treatment and treatment outcomes were analyzed. Results: 5145 cases of patients underwent thyroid radical resection and central lymph node dissection for thyroid cancer during the past 6 years. No chylous leakage was found in any patient intraoperatively. However postoperative chylous leakage was detected in 13 patients. There was no correlation between chyle leakage and age (p=0.7448), sex (p=0.446), tumor type (p=0.328), unilateral or bilateral central lymph node dissection (p=0.067), T stage (p=0.131), N stage (p=0.666), M stage (p=1.000), UICC stage (p=1.000), number of the central region lymph node metastasis(p=0.593); But Chyle leakage was related to the number of dissected central region of lymph nodes (p <;0.001). Pressure dressing, neck suction drainage and low-fat diet were used. 24 hours peak drainage volume was 83±60ml (mean± standard deviation, the same below); Drainage tube removal time was 7.2±3.0 days postoperatively; Drainage triglyceride concentrations increased and was higher than serum triglyceride levels in 8 cases of patients who was tested drainage and serum triglyceride concentration. No patient experienced significant weight loss, hypoalbuminemia, electrolyte imbalance, subcutaneous fluid, wound infection and other symptoms. There was no recurrence of chylous leak during Follow-up of 1-3 years. Conclusion: Compared with cervical lymph node dissection, chylous leakage in patients who underwent thyroid cancer radical resection and central lymph node dissection was more rare and had less drainage volume, had less effect on patients.This kind of chylous leakage can be cured mostly under positively conservative treatment. If larger number of lymph nodes were dissected for central region dissection, we need pay more attention to prevent postoperative chylous leakage.