高渗糖局部注射治疗甲状腺癌颈部淋巴结清扫术后淋巴漏疗效分析
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摘要
目的探讨高渗糖局部注射用于甲状腺癌术后淋巴漏病人的疗效。方法回顾性分析郑州大学第一附属医院甲状腺外一科2017年2月至2018年12月术后出现难治性淋巴漏并行高渗糖注射的9例病人资料。结果 9例病人中,8例应用高渗糖后引流液持续减少并最终拔管,3例首次应用且引流液下降50%以上,4例病人连续注射2 d高渗糖后引流液下降50%以上,1例病人经注射高渗糖无效后,行二次手术结扎,并最终拔管。结论对于甲状腺癌术后合并难治性淋巴漏病人,采用高渗糖局部注射治疗,可促进创面愈合,减少病人痛苦。
Objective To investigate the effect of hypertonic glucose injection on patients with chylous leakage after neck dissection.Methods The clinical data of 9 patients with postoperative chylous fistula after the lymph node dissection of thyroid cancer from February 2017 to December 2018 in the Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University were collected and analyzed.Results As for 9 patients with intractable chylous fistula,8 patients were finally cured and had the drainage tube removed.Three patients decreased significantly by over 50% on next day after hypertonic glucose injection.Four patients decreased significantly by over 50% on next two daysafter hypertonic glucose injection.One patient had to have another one operation to cure chylous fistula.Conclusion In patients with chylous fistula after thyroid cancer surgery,local injection of hypertonic glucose seems to be more effective in shortening time of drainage tube remining,which would promote wound healing and release pains.
Objective To investigate the effect of hypertonic glucose injection on patients with chylous leakage after neck dissection.Methods The clinical data of 9 patients with postoperative chylous fistula after the lymph node dissection of thyroid cancer from February 2017 to December 2018 in the Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University were collected and analyzed.Results As for 9 patients with intractable chylous fistula,8 patients were finally cured and had the drainage tube removed.Three patients decreased significantly by over 50% on next day after hypertonic glucose injection.Four patients decreased significantly by over 50% on next two daysafter hypertonic glucose injection.One patient had to have another one operation to cure chylous fistula.Conclusion In patients with chylous fistula after thyroid cancer surgery,local injection of hypertonic glucose seems to be more effective in shortening time of drainage tube remining,which would promote wound healing and release pains.
引文
[1]卢秀波.甲状腺乳头状癌中央区及颈侧区淋巴结转移相关因素探讨[J].中国实用外科杂志,2017,37(9):952-955.
[2]梅洁,苏新良.甲状腺癌颈清扫术后淋巴漏39例分析[J].第三军医大学学报,2017,39(4):385-389.
[3]殷德涛,刘晨光.甲状腺癌的放射治疗[J].中国实用外科杂志,2019,39(3):206-208.
[4]董凌翔,贺亮,张浩,等.甲状腺癌中央区淋巴结清扫术后并发乳糜漏14例临床分析[J].中国实用外科杂志,2019,39(2):173-177.
[5]Nowak K,Wierzbicka M,Szyfter W,et al.Chylous leakage--rare but still dangerous complication after neck surgery[J].Otolaryngol Pol,2011,65(2):128-131.
[6]Ahn D,Sohn JH,Jeong JY.Chyle fistula after neck dissection:an8-year,single-center,prospective study of incidence,clinical features,and treatment[J].Ann Surg Oncol,2015,22(3):1000-1006.
[7]刘琼,肖力.胸腔注射高渗糖水治疗胸部手术后肺持续漏气的护理[J].护士进修杂志,2015,30(22):2098-2099.
[8]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),2018,39(1):13-16.
[9]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.
[10]陈朔,Bivekkarki,陈杰.胸导管的磁共振水成像研究[J].国际医学放射学杂志,2012,35(6):533-535.
[11]Johnson OW,Chick JF,Chauhan NR,et al.The thoracic duct:clinical importance,anatomic variation,imaging,and embolization[J].Eur Radiol,2016,26(8):2482-2493.
[12]储康宁,刘业海,赵益,等.颈清扫乳糜漏的术中预防[J].中国耳鼻咽喉头颈外科,2012,19(4):169-171.
[13]雷滋华,钟国发,刘辉,等.生长抑素与阿托品在颈部手术后乳糜漏保守治疗中的应用探讨[J].河南外科学杂志,2016,22(5):1-2.
[14]Lorenz K,Abuazab M,Sekulla C,et al.Management of lymph fistulas in thyroid surgery[J].Langenbecks Arch Surg,2010,395(7):911-917.
[15]谢礼波,符磊,何绍锋,等.生长抑素在肾移植后淋巴漏治疗中的应用17例[J].中华器官移植杂志,2013,34(2):123-124.
[16]章玉英,马纯雪,于冬芳,等.生长抑素用于腹部手术后胃瘫综合征患者的疗效观察[J].海峡药学,2012,24(4):166-168.
[17]蔡怀阳,殷飞.生长抑素的临床应用进展[J].临床荟萃,2008,23(20):1517-1519.
[18]朱惠,马莉敏,夏芳珍,等.早期2型糖尿病患者血浆生长抑素、胰高血糖素样肽1和胰升糖素水平的变化[J].上海交通大学学报(医学版),2012,32(3):340-343.
[19]李静.50%高渗糖治疗感染性溃疡期褥疮效果观察[J].山东医药,2005,45(26):91-92.
[20]余南彬,刘伦旭,蒲江涛.50%葡萄糖溶液在肺手术后持续肺漏气治疗中的应用[J].中国胸心血管外科临床杂志,2007,14(3):239.
[21]Blonski WC,Campbell MS,Faust T,et al.Successful aspiration and ethanol sclerosis of a large,symptomatic,simple liver cyst:case presentation and review of the literature[J].World J Gastroenterol,2006,12(18):2949-2954.
[2]梅洁,苏新良.甲状腺癌颈清扫术后淋巴漏39例分析[J].第三军医大学学报,2017,39(4):385-389.
[3]殷德涛,刘晨光.甲状腺癌的放射治疗[J].中国实用外科杂志,2019,39(3):206-208.
[4]董凌翔,贺亮,张浩,等.甲状腺癌中央区淋巴结清扫术后并发乳糜漏14例临床分析[J].中国实用外科杂志,2019,39(2):173-177.
[5]Nowak K,Wierzbicka M,Szyfter W,et al.Chylous leakage--rare but still dangerous complication after neck surgery[J].Otolaryngol Pol,2011,65(2):128-131.
[6]Ahn D,Sohn JH,Jeong JY.Chyle fistula after neck dissection:an8-year,single-center,prospective study of incidence,clinical features,and treatment[J].Ann Surg Oncol,2015,22(3):1000-1006.
[7]刘琼,肖力.胸腔注射高渗糖水治疗胸部手术后肺持续漏气的护理[J].护士进修杂志,2015,30(22):2098-2099.
[8]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),2018,39(1):13-16.
[9]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.
[10]陈朔,Bivekkarki,陈杰.胸导管的磁共振水成像研究[J].国际医学放射学杂志,2012,35(6):533-535.
[11]Johnson OW,Chick JF,Chauhan NR,et al.The thoracic duct:clinical importance,anatomic variation,imaging,and embolization[J].Eur Radiol,2016,26(8):2482-2493.
[12]储康宁,刘业海,赵益,等.颈清扫乳糜漏的术中预防[J].中国耳鼻咽喉头颈外科,2012,19(4):169-171.
[13]雷滋华,钟国发,刘辉,等.生长抑素与阿托品在颈部手术后乳糜漏保守治疗中的应用探讨[J].河南外科学杂志,2016,22(5):1-2.
[14]Lorenz K,Abuazab M,Sekulla C,et al.Management of lymph fistulas in thyroid surgery[J].Langenbecks Arch Surg,2010,395(7):911-917.
[15]谢礼波,符磊,何绍锋,等.生长抑素在肾移植后淋巴漏治疗中的应用17例[J].中华器官移植杂志,2013,34(2):123-124.
[16]章玉英,马纯雪,于冬芳,等.生长抑素用于腹部手术后胃瘫综合征患者的疗效观察[J].海峡药学,2012,24(4):166-168.
[17]蔡怀阳,殷飞.生长抑素的临床应用进展[J].临床荟萃,2008,23(20):1517-1519.
[18]朱惠,马莉敏,夏芳珍,等.早期2型糖尿病患者血浆生长抑素、胰高血糖素样肽1和胰升糖素水平的变化[J].上海交通大学学报(医学版),2012,32(3):340-343.
[19]李静.50%高渗糖治疗感染性溃疡期褥疮效果观察[J].山东医药,2005,45(26):91-92.
[20]余南彬,刘伦旭,蒲江涛.50%葡萄糖溶液在肺手术后持续肺漏气治疗中的应用[J].中国胸心血管外科临床杂志,2007,14(3):239.
[21]Blonski WC,Campbell MS,Faust T,et al.Successful aspiration and ethanol sclerosis of a large,symptomatic,simple liver cyst:case presentation and review of the literature[J].World J Gastroenterol,2006,12(18):2949-2954.