Lee Junghyun, Bae In Eui, Yoon Jin, Lee Keunchul, Yu Hyeong Won, Kim Su-Jin, Chai Young Jun, Choi June Young, Lee Kyu Eun
Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do 13620, Korea.
Department of Surgery, Konyang University Hospital, Daejeon 35365, Korea.
Medicina (Kaunas). 2020 Sep 21;56(9):481. doi: 10.3390/medicina56090481.
: Currently, few studies have been conducted on postoperative chylothorax, specifically in total thyroidectomy with modified radical neck dissection (MRND) in papillary thyroid carcinoma patients. This study provides the actual incidence, etiology, and clinical features of postoperative chylothorax and reports the clinical outcomes after treatment, which were dependent upon the severity of the complications. : The medical charts of 111 papillary thyroid cancer (PTC) patients who underwent total thyroidectomy with modified radical neck dissection from January 2016 to December 2018 were reviewed retrospectively. The results were compared in three groups: the no chylothorax group, the subclinical (asymptomatic) group, and the clinical (symptomatic) group. Chylothorax occurred in 23 patients (20.7%, 23/111). Nineteen (82.6%, 19/23) were subclinical chylothorax cases, which implies a small amount of chyle leakage with no respiratory symptoms. Four (17.4%, 4/23) were clinical, meaning they had either respiratory symptoms, such as dyspnea, desaturation, or a large amount of chylothorax in the images. The incidence was significantly higher in patients who underwent left modified radical neck dissection, and this corresponds to the side in which chylothorax occurred. There were also statistical differences in the drainage color, peak amount, or drain removal time. Postoperative chylothorax is a rare complication following neck dissection. However, it can be fatal if the condition progresses. Therefore, patients who undergo total thyroidectomy with modified radical neck dissection, especially on the left side, should be monitored for respiratory symptoms, and serial chest x-ray images obtained.
目前，关于术后乳糜胸的研究较少，尤其是针对甲状腺乳头状癌患者行全甲状腺切除加改良根治性颈清扫术（MRND）后的乳糜胸。本研究提供了术后乳糜胸的实际发病率、病因及临床特征，并报告了根据并发症严重程度进行治疗后的临床结果。回顾性分析了2016年1月至2018年12月期间111例行全甲状腺切除加改良根治性颈清扫术的甲状腺乳头状癌（PTC）患者的病历。将结果在三组中进行比较：无乳糜胸组、亚临床（无症状）组和临床（有症状）组。23例患者（20.7%，23/111）发生了乳糜胸。19例（82.6%，19/23）为亚临床乳糜胸病例，这意味着有少量乳糜漏出且无呼吸道症状。4例（17.4%，4/23）为临床病例，即他们有呼吸困难、血氧饱和度下降等呼吸道症状，或影像学检查显示有大量乳糜胸。行左侧改良根治性颈清扫术的患者发病率显著更高，且这与乳糜胸发生的一侧相对应。在引流液颜色、峰值量或拔管时间方面也存在统计学差异。术后乳糜胸是颈清扫术后一种罕见的并发症。然而，如果病情进展，可能会致命。因此，对于行全甲状腺切除加改良根治性颈清扫术的患者，尤其是左侧手术的患者，应监测其呼吸道症状，并定期进行胸部X线检查。
