Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (3): 64-68.doi: 10.6040/j.issn.1673-3770.1.2020.040

Previous Articles     Next Articles

Combined treatment of chylous leakage after lymph node dissection for thyroid cancer

FANG Zhongju1, ZHANG Yongxia2, ZHAO Jiandong2, ZONG Liang2, ZHAI Xingyou3, LI Xinjian3, PENG Xin3, REN Nan3, CHEN Liwei2, LIU Mingbo2,3   

  1. 1. Department of ENT, Weifang Medical University, Weifang 261053, Shandong, China;
    2. Department of Otolaryngology-Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital/National Clinical Research Center for Otolaryngologic Diseases, Beijing 100853, China;
    3. Department of Otolaryngology Head and Neck Surgery, Hainan Hospital of Chinese PLA General Hospital/The Clinical Medical Research Center for Otolaryngology Head and Neck Surgery of Hainan Provincial, Sanya 572013, Hainan, China
  • Online:2020-05-20 Published:2020-06-29

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

CLC Number: 

  • R736.1
[1] 李真华, 葛家华, 汤喜, 等. 颈淋巴结清扫术后乳糜漏21例分析[J]. 重庆医学, 2015, 44(14): 1904-1905. LI Zhenhua, GE Jiahua, TANG Xi, et al. Analysis on 21 cases of chylous fistula after neck lymph nodes dissection [J]. Chongqing Medical Journal, 2015, 44(14): 1904-1905.
[2] 韦伟, 李朋. 甲状腺癌颈淋巴结清扫术常见并发症及其防治[J]. 中国实用外科杂志, 2017, 37(9): 970-973. doi: 10.19538/j.cjps.issn1005-2208.2017.09.10. WEI Wei, LI Peng. Major complications and prevention of cervical lymph node dissection for thyroid carcinoma [J]. Chinese Journal of Practical Surgery, 2017, 37(9): 970-973. doi: 10.19538/j.cjps.issn1005-2208.2017.09.10.
[3] Claeys T, van Praet C, Lumen N, et al. Salvage pelvic lymph node dissection in recurrent prostate cancer: surgical and early oncological outcome [J]. Biomed Res Int, 2015, 2015: 198543. doi:10.1155/2015/198543.
[4] Louzada AC, Lim SJ, Pallazzo JF, et al. Biometric measurements involving the terminal portion of the thoracic duct on left cervical level IV: an anatomic study [J]. Anat Sci Int, 2016, 91(3): 274-279. doi: 10.1007/s12565-015-0295-9.
[5] 徐震纲, 刘绍严, 朱一鸣. 分化型甲状腺癌颈侧区淋巴结清扫专家共识(2017版)[J]. 中国实用外科杂志, 2017, 37(9): 985-991. doi: 10.19538/j.cjps.issn1005-2208.2017.09.13.
[6] 邱体红, 付再碧. 甲状腺癌颈部淋巴结清扫术后并发乳糜漏的防治[J]. 现代仪器与医疗, 2016, 22(3): 23-25. doi: 10.11876/mimt201603009. QIU Tihong, FU Zaibi. Prevention and treatment of chylous leakage after dissection of neck lymph nodes during thyroid cancer surgery [J]. Modern Instruments and Medical, 2016, 22(3): 23-25. doi: 10.11876/mimt201603009.
[7] 冯嘉麟, 周秦毅, 陈隽, 等. 甲状腺癌中央区淋巴清扫术后乳糜漏的临床分析[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(8): 597-600. doi: 10.3760/cma.j.issn.1673-0860.2019.08.007. FENG Jialin, ZHOU Qinyi, CHEN Jun, et al. Analysis of chyle leakage after central lymph node dissection for thyroid carcinoma [J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2019, 54(8): 597-600. doi: 10.3760/cma.j.issn.1673-0860.2019.08.007.
[8] Polistena A, Vannucci J, Monacelli M, et al. Thoracic duct lesions in thyroid surgery: an update on diagnosis, treatment and prevention based on a cohort study [J]. Int J Surg, 2016, 28(Suppl 1): S33-S37. doi: 10.1016/j.ijsu.2015.05.058.
[9] Noma K, Kashima H, Ninomiya T, et al. Therapeutic potential of targeting cancer-associated fibroblasts in esophageal cancer [J]. Gan To Kagaku Ryoho, 2015, 42(10): 1228-1230.
[10] 李素芳. 甲状腺癌颈淋巴结清扫术后并发乳糜漏临床分析[J]. 中华实用诊断与治疗杂志, 2016(9): 935-936. doi: 10.13507/j.issn.1674-3474.2016.09.037.
[11] Kim HK, Kim SM, Chang H, et al. Clinical experience with n-butyl-2-cyanoacrylate in performing lateral neck dissection for metastatic thyroid cancer [J]. Surg Innov, 2016, 23(5): 481-485. doi:10.1177/1553350616628683.
[12] de Steur WO, Hartgrink HH, Dikken JL, et al. Quality control of lymph node dissection in the Dutch Gastric Cancer Trial [J]. Br J Surg, 2015, 102(11): 1388-1393. doi:10.1002/bjs.9891.
[13] 冯云, 钟志明, 陈国庆. 纳米碳在甲状腺乳头状癌隐匿性侧颈转移淋巴结清扫术中的临床应用价值[J].山东大学耳鼻喉眼学报, 2020, 34(3): 101-106。DOI:10.6040/j.issn.1673-3770.1.2020.024. FENG Yun, ZHONG Zhiming, CHEN Guoqing. Clinical value of nano-carbon in the dissection of occult lateral cervical metastatic lymph nodes in papillary thyroid carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 101-106. doi: 10.6040/j.issn.1673-3770.1.2020.024.
[14] 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 甲状腺外科能量器械应用专家共识(2017版)[J].中国实用外科杂志, 2017, 37(9): 992-997. doi: 10.19538/j.cjps.issn1005-2208.2017.09.14.
[15] 姚遥, 刘业海, 吴开乐, 等. 超声刀在颈清扫术中有效性及安全性的Meta分析[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(10): 915-920. doi: 10.13201/j.issn.1001-1781.2015.10.013. YAO Yao, LIU Yehai, WU Kaile, et al. Efficacy and safety of harmonic scalpel in neck dissection: a Meta-analysis [J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015, 29(10): 915-920. doi: 10.13201/j.issn.1001-1781.2015.10.013
[16] Swanson MS, Hudson RL, Bhandari N, et al. Use of octreotide for the management of chyle fistula following neck dissection [J]. JAMA Otolaryngol Head Neck Surg, 2015, 141(8): 723-727. doi: 10.1001/jamaoto.2015.1176.
[17] 柳桢, 殷德涛, 马润声, 等. 奥曲肽治疗甲状腺癌颈淋巴结清扫术后难治性淋巴漏14例临床分析[J]. 西安交通大学学报(医学版), 2018(1): 13-16. doi: 10.7652/jdyxb201801004. LIU Zhen, YIN Detao, MA Runsheng, et al. Clinical analysis of 14 cases of refractory lymphatic leakage after cervical lymph node dissection treated with octreotide [J]. Journal of Xi’an Jiaotong University(Medical Sciences), 2018(1): 13-16. doi: 10.7652/jdyxb201801004.
[18] 向德森, 肖杰, 冉文华, 等. 持续负压吸引在肝癌肝切除术后淋巴漏中的应用[J]. 中国医药导刊, 2015(4): 330-332. XIANG Desen, XIAO Jie, RAN Wenhua, et al. Continuous negative pressure suction in the application of the lymphatic leakage in liver cancer after resection [J]. Chinese Journal of Medicinal Guide, 2015, 4: 330-332.
[19] 费翔, 崔建春, 毕冬宁, 等. 甲状腺癌中央组淋巴结清扫术后乳糜漏治疗策略及新方法(附2例报道)[J]. 中国普外基础与临床杂志,2020,27(3):350-352. doi:10.7507/1007-9424.201907026.
[20] 李萍, 漆白文, 丁俊辉, 等. 负压封闭引流在16例淋巴漏治疗中的临床应用[J]. 临床外科杂志, 2015(3): 228-230. doi:10.3969/j.issn.1005-6483.2015.03.32. LI Ping, QI Baiwen, DING Junhui, et al. The clinical application of vacuum sealing drainage in the treatment of lymphatic leakage[J]. Journal of Clinical Surgery, 2015(3): 228-230. doi: 10.3969/j.issn.1005-6483.2015.03.32.
[21] 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. doi: 10.1111/ases.12268.
[1] QING Xiaoyan, XU YiquanOverview, LI ChaoGuidance. Advances in molecular mechanisms of anaplastic thyroid cancer [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 26-31.
[2] DENG Di, LIU Jun, LI Linke, WANG Ji, LIU Jifeng, LV Dan, WANG Haiyang, GAN Weigang, WANG Jun, LI Bo, CHEN Fei. Two-stage reconstructive strategy using a flap for non-circumferential tracheal defects [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 52-57.
[3] HUANG Naisi, MA Ben, GUAN Qing, WANG Yunjun, WEI Wenjun, LU Zhongwu, YANG Shuwen, XU Weibo, XIANG Jun, JI Qinghai, WANG Yu. Lateral neck lymph node mapping in thyroid cancer surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 69-74.
[4] LÜ Jingrong, CHEN Chun, MA Yan, XIE Jin. Clinical characteristics and risk factors for differentiated thyroid carcinoma in children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 88-94.
[5] MA Chi, ZHENG Guibin, SUN Haiqing, WU Guochang, GUO Yawen, KONG Yang, SONG Xicheng, ZHENG Haitao. Enhanced recovery after surgery applied to 100 cases of thyroid cancer surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 107-110.
[6] JIANG Xiuying, LI Yuanbin. Clinical analysis of posterior intraocular lens dislocation [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 105-110.
[7] XU Shuhang, LI Chunrui, LIU Chao. Optimal management of differentiated thyroid carcinoma in children. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(6): 12-15.
[8] SUN Bin, GUO Bomin, KANG Jie, DENG Xianzhao, WU Bo, FAN Youben. Standardization of the diagnosis and treatment of anaplastic thyroid carcinoma. [J]. J Otolaryngol Ophthalmol Shandong Univ, 2017, 31(6): 16-20.
[9] SUN Guochen, SUN Yan, ZHANG Hong, WANG Baowei. Clinical characteristics and treatment of differentiated thyroid carcinoma in children. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(6): 25-28.
[10] PAN Yongjie, PANG Wenhui, SUN Guochen, SUN Yan, ZHANG Hong. Expression and clinical significance of Heparanase and D2-40 in pediatric thyroid carcinoma. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(6): 29-32.
[11] HUO Hong, LI Wuyi, WANG Jian, YANG Dahai, JIN Xiaofeng, TIAN Xu, NIU Yanyan.. Treatment of pharyngeal stenosis following uvulopalatopharyngoplasty with coblation. [J]. J Otolaryngol Ophthalmol Shandong Univ, 2017, 31(6): 58-61.
[12] GONG Shanchun, ZHANG Haidong, ZHANG Qingxiang, HE Shuangba, YU Zhenkun. Meticulous operation of thyroid iobectomy. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(2): 5-9.
[13] HUANG Xiaoming, LIANG Faya, YU Shitong. Surgical treatment of papillary thyroid carcinoma under endoscopy. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(2): 13-16.
[14] WANG Yu, MA Ben. Ultrasound guided thermoablation does not fit for thyroid carcinoma and follicular neoplasm. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(2): 20-22.
[15] CHEN Xiaohong. Precision therapy on medullary thyroid carcinoma. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(2): 23-27.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] LIN Bin,WANGHui-ge . Functional endoscopic sinus surgery, FESS[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(6): 481 -487 .
[2] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 84 -87 .
[3] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(2): 116 -118 .
[4] ZHOU Zi-ning,JIN Guo-wei . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(5): 462 -465 .
[5] GONG Lei,SUN Jie,XUE Zi-chao,LI Jing-hua,XUE Wei-guo . DNA analysis of the cell cycle in sino-nasal neoplasm[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 193 -195 .
[6] CHEN Wen-wen . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(5): 472 -472 .
[7] ZHOU Bin,LI Bin . Endoscopic sinus surgery for 75 patients with chronic sinusitis and nasal polyps[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 24 -26 .
[8] YANG Changliang,HUANG Zhiwu,YAO Hangqi,ZHU Yong,SNU Yi . Study on auditory brainstem response[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 9 -13 .
[9] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 89 -89 .
[10] LUAN Jiangang,LIANG Chuanyu,WEN Yanjun,LI Jiong . Construction of RNAi expressing plasmid vector of pSIRENshuttle for EGFR gene silencing[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 4 -8 .