Đánh giá kết quả nút tắc ống ngực điều trị biến chứng rò dưỡng chấp sau mổ ung thư tuyến giáp

Abstract

Chylous leakage after operation of head and neck is a rare but well-known complication. Patients with this complication can be treated conservatively but in patients with high flow leakage, the subsequent treatments will be very complicated. The objective of the study was to report the results of percutaneous thoracic duct embolization (TDE) treatment for chylous leakage of the neck in patients post thyroidectomy and cervical lymph node. Fifteen consecutive patients underwent thoracic duct embolization treatment after failed conservative treatment. They were all designated to do MR lymphagiography to depict the thoracic duct (TD) lesion before intervention for TDE. Results shown that fifteen patients with chylous drainage more than 500 ml/day during average 2 weeks (1 to 5 weeks) were indicated for intervention treatment. MR lymphagiography showed extravasation of contrast at the left neck in all patients. Successful TDE was achieved in 15/15 patients in which 13/15 patients were punctured through the cisterna chili to cannulate the guide wire into the TD; of two patients we failed to cannulate the guide wire into the thoracic duct from the cisterna chyli, one patient was punctured into the distal end of TD under fluoroscopy guidance and one was punctured into the TD under CT scanner guidance. No major complication was noted. All patients were discharged in following weeks after intervention. Conclusion: TDE is minimally invasive and is effective for treatment of cervical chylous leakage post thyroidectomy.