关键词: 甲状腺癌, 术后并发症, 乳糜漏, 颈淋巴结清扫术

Abstract: Objective To explore the causes and treatment of chyle leakage after lymph node dissection(LND)for thyroid carcinoma. Methods A retrospective analysis was conducted in 647 patients who underwent LND for thyroid carcinoma. For the 11 patients who developed chyle leakage, measures such as intravenous nutrition, low-fat diet, local compression and negative pressure drainage were taken. Results Chylous leakage occurred on day 0.5 to 3 after surgery, and the incidence was 1.7%. The peak drainage of chylous leakage was 120 to 1100 mL/d. Unilateral lobectomy + isthmectomy was performed in 449 cases, total thyroidectomy in 152 cases, and unilateral lobectomy + isthmectomy + contralateral subtotal thyroidectomy in 46 cases. Simple central lymph node dissection was performed in 395 cases, 5 of whom developed chyle leakage, and the incidence was 1.26%(5/395). Lateral neck+central lymphatic dissection was performed in 83 cases, 4 of whom developed chyle leakage, and the incidence was 4.8%(4/83). Upper mediastinal dissection with endoscope was performed in 6 cases, 2 of whom developed chyle leakage, and the incidence was 33.3%(2/6). The ratio of left to right chylous leakage was 7:4. Three patients had relapse dissection(rRLN). When the daily drainage volume was less than 20 mL/d, the drainage tube was removed. The closing time of chylous leakage was 6 to 23 days, median 11 days. No second operation was performed. Conclusion When lymph node dissection for thyroid carcinoma is performed, the procedures should be standardized to prevent chylous leakage. In case chylous leakage occurs, measures such as diet adjustment and negative pressure drainage can help the cure. Surgery must be performed when the conservative treatment is ineffective.

Key words: Thyroid carcinoma, Postoperative complications, Chylous fistula, Neck lymph node dissection