Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China.
Department of Breast and Thyroid Surgery, Qijiang Maternal and Child Health Hospital, Chongqing, China.
Am J Case Rep. 2024 Jul 19;25:e944579. doi: 10.12659/AJCR.944579.
BACKGROUND Massive chylous leakage represents a rare yet potentially life-threatening complication following neck dissection, and its occurrence is even less common in the context of endoscopic thyroid surgery. Chylous leakage poses significant clinical management challenges, encompassing prolonged hospitalization, nutritional deficiencies, electrolyte imbalances, and the potential for infection. It is imperative for surgeons to remain vigilant and proactive in recognizing and managing chylous leakage to mitigate its potential impact on patient outcomes. CASE REPORT A 37-year-old woman presented with a thyroid nodule, and subsequent fine-needle aspiration biopsy confirmed the diagnosis of papillary thyroid carcinoma. She then underwent endoscopic thyroidectomy with central lymph node dissection via a bilateral areola approach and experienced significant postoperative chylous leakage. Various conservative management strategies were used to treat the leak, including fasting, parenteral nutrition, maintenance of electrolyte balance, and continuous infusion of somatostatin. After failure of a series of conservative treatments, the patient underwent a reoperation to address the leak via the initial approach. After identification of the leak site, the residual end of the lymphatic vessel was clamped with a biological clamp, and no further chylous leakage was observed. The drainage was removed 4 days after the second operation, and the patient was discharged on the fifth day. During follow-up, no abnormalities were observed. CONCLUSIONS Managing significant chylous leakage poses a challenge for surgeons. This complication is rare following endoscopic thyroidectomy with central lymph node dissection, and there remains a lack of experience in effective prevention and treatment. We aim to raise awareness through our case report.
大量乳糜漏是颈部清扫术后一种罕见但潜在危及生命的并发症，在腔镜甲状腺手术中更为少见。乳糜漏给临床管理带来了巨大挑战，包括延长住院时间、营养缺乏、电解质失衡和感染的风险。外科医生必须保持警惕并积极识别和处理乳糜漏，以减轻其对患者预后的潜在影响。
一名 37 岁女性因甲状腺结节就诊，随后的细针穿刺活检证实为甲状腺乳头状癌。她接受了腔镜甲状腺切除术和中央淋巴结清扫术，通过乳晕双侧入路进行，术后出现大量乳糜漏。采用了多种保守治疗策略来治疗漏液，包括禁食、肠外营养、维持电解质平衡和持续输注生长抑素。一系列保守治疗失败后，患者通过原切口再次手术以解决漏液问题。在确定漏液部位后，用生物夹夹住淋巴管的残端，此后未再观察到乳糜漏。第二次手术后 4 天拔除引流管，第五天患者出院。随访期间无异常。
处理大量乳糜漏对外科医生来说是一个挑战。这种并发症在腔镜甲状腺切除术和中央淋巴结清扫术后很少见，目前在预防和治疗方面经验有限。我们希望通过病例报告来提高对此的认识。
