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同種異體腎移植術后并發乳糜漏護理一例

甲狀腺癌中央組淋巴結清掃術后乳糜漏治療策略及新方法（附 2 例報道）

目的探討甲狀腺癌中央組淋巴結清掃術后乳糜漏的治療策略重點及介紹一種新方法。方法回顧性分析 2019 年 3～5 月期間遼寧省人民醫院甲狀腺乳腺外科收治的 2 例甲狀腺癌中央組淋巴結清掃術后輕中度乳糜漏患者，采取頸托外固定加棉球內填塞加壓包扎加充分負壓引流并輔助低脂飲食的保守治療方法（其中 1 例患者為在外院采取禁食水、靜脈營養、局部鹽袋壓迫等方法保守治療 3 周拔管后乳糜漏復發而來我院就診）。結果2 例患者的引流量均在 2 d 內快速減少到 10 mL 以下，繼續維持治療 10 d 后恢復正常飲食 3 d，然后觀察引流液量無變化時于第 14 天撥除引流管，撥管后再觀察 3 d 后復查頸部超聲示仍無明顯積液時提示淋巴漏已臨床治愈。結論局部壓迫、充分引流、減少淋巴液生成是治愈甲狀腺癌術后輕中度乳糜漏的策略重點；頸托外固定加棉球內填塞的加壓包扎是對頸根部進行加壓包扎的一種新方法，低脂飲食是減少淋巴液產生的有效手段。

Clinical effect of refractory chylous leakage treated by Jindan Fuyan Granule after neck lymph node dissection for thyroid cancer: a report of 3 cases

ObjectiveTo summarize the efficacy and safety of Jindan Fuyan Granule in the treatment of refractory chylous leakage after neck lymph node dissection for thyroid cancer. MethodThe clinical data of thyroid cancer patients with refractory chylous leakage after neck lymph node dissection treated with Jindan Fuyan Granules in the Department of Head and Neck Surgery of Jiangsu Cancer Hospital from January to December 2023, were retrospectively collected. ResultsAfter treatment with Jindan Fuyan Granules on the basis of conventional treatment, the drainage volume of 3 patients with thyroid cancer after radical neck lymph node dissection was significantly reduced, from 100 mL to 2 mL, 1 285 mL to 5 mL, and 960 mL to 5 mL, respectively. After 3 days of treatment, the tubes were removed successfully. After discharge from the hospital, 3 patients were followed up for 3, 3, 4 months, respectively, showing satisfactory wound healing without chylous leakage or other discomfort. ConclusionsCombined with low-fat diet, drainage and other non-surgical treatment methods, Jindan Fuyan Granule has obvious effect on treating refractory chylous fistula after neck lymph node dissection, which can be used as a non-surgical treatment option. However, the efficacy needs to be further verified.

Prevention and Treatment on Chyle Leakage after Radical Neck Dissection of Thyroid Carcinoma (Report of 19 Cases)

目的 探討臨床上更加有效地預防和治療頸乳糜漏的方法。方法 我科1988～2008年期間共收治593例行甲狀腺癌頸淋巴結清掃術的患者，對術后出現乳糜漏的患者的臨床資料進行總結分析。結果 共出現頸乳糜漏19例，占3.2%，其中17例采用持續負壓吸引加局部加壓包扎的保守治療方法治愈，2例采用淋巴管縫扎方法治愈。結論 持續負壓吸引加局部加壓包扎是治療甲狀腺癌頸淋巴結清掃術后乳糜漏的主要治療方法，對于引流量較大、持續時間較長的病例應采用手術治療的方法。

甲狀腺癌頸淋巴結清掃術后難治性乳糜漏臨床分析

目的 分析甲狀腺癌手術后難治性乳糜漏的臨床特點，探討難治性乳糜漏的治療策略。方法 回顧性分析解放軍第九六〇醫院（原濟南軍區總醫院）2009年 1 月至 2021 年1 月期間收治的 5 021例行甲狀腺癌頸淋巴結清掃術患者的臨床資料，術后發生乳糜漏122例，其中治療時間超過2周的難治性乳糜漏34例，對難治性乳糜漏患者的一般情況、治療方式、峰值引流量（日最高引流量）、帶管時間等進行分析總結。結果 5 021例患者中發生乳糜漏122例，占所有患者的2.4%。經非手術治療2周內治愈者88例，占乳糜漏總數的72.1%；治療時間超過2周的難治性乳糜漏34例，占乳糜漏總數的27.9%。難治性乳糜漏經非手術方法治愈者18例，經再次手術治愈者16例，2組患者的乳糜漏位置左側多于右側；34例難治性乳糜漏峰值引流量（日最高引流量）手術組（16例）高于非手術組（P<0.05），帶管時間手術組短于非手術組（P<0.05）。結論 低峰值引流量乳糜漏經非手術治療多可治愈；難治性乳糜漏左側多見，高流量乳糜漏（峰值引流量≥1 000 mL）宜早期實施手術治療。

Chyle Leakage after Radical Neck Dissection

頸淋巴結清掃術后乳糜漏是頸部外科手術后比較少見的并發癥，國內、外文獻［1-7］報道其發生率約為1%～3%，其原因很明確，即術中損傷胸導管或其分支。頸淋巴結清掃術后乳糜漏對生命有潛在威脅，且顯著延長患者住院時間、增加醫療費用。盡管手術方法及手術器械不斷改進，其發生率并沒有明顯降低，對于部分難治性乳糜漏目前還沒有簡單有效的辦法。現就頸淋巴結清掃術后乳糜漏的預防及治療方法介紹如下……

Advances in the diagnosis and management of chyle leak following gastric cancer surgery

ObjectiveTo review the advances in the pathogenesis, diagnostic modalities, treatment strategies, and preventive measures of chyle leak following gastric cancer surgery, aiming to provide an evidence-based reference for clinical practice. MethodsRecent domestic and international studies concerning the risk factors and management of postoperative chyle leak in gastric cancer were retrieved and systematically analyzed. ResultsPostoperative chyle leak is primarily caused by extensive lymphadenectomy. Advanced age, obesity, and extended lymph node dissection are identified as high-risk factors. The diagnosis can be confirmed by analyzing the characteristics and triglyceride concentration of the drainage fluid, while imaging techniques facilitate the precise localization of the leak. The majority of patients can be cured with conservative management, encompassing fasting, a medium-chain triglyceride diet, and somatostatin therapy. For high-output or refractory cases, interventional radiology or surgical treatments are indicated. ConclusionsThe management of post-gastrectomy chyle leak should adhere to the comprehensive principles of “perioperative prevention, early recognition, and standardized intervention”. Future multicenter randomized controlled trials and the development of risk prediction models are warranted to provide high-level evidence for individualized clinical decision-making and further improve patients’ outcomes.