Short-term efficacy and safety of percutaneous ultrasound-guided pseudomonas aeruginosa-mannose sensitive hemagglutinin injection in postoperative chyle fistula: a cohort study.

OBJECTIVE

Postoperative chyle fistula is a rare but serious complication following total thyroidectomy with neck dissection, with an incidence of 3%-8% in high-risk patients. Given the variable effectiveness of conservative therapy, this study aimed to evaluate the short-term efficacy and safety of percutaneous ultrasound-guided pseudomonas aeruginosa-mannose-sensitive hemagglutinin (PA-MSHA) injection in postoperative patients.

METHODS

This retrospective single-center cohort study included 78 patients with papillary thyroid carcinoma who developed postoperative chyle fistula after total thyroidectomy with lateral neck dissection. Patients received either PA-MSHA injection (Group A) or standard conservative therapy including somatostatin and adhesion-agent injection (Group B). Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics. Primary endpoints included postoperative length of stay (LOS), number of drug injections, readmission rates, daily drainage volume, and inflammatory responses. Secondary endpoints included side of leakage, unilateral drainage volume and demographic data.

RESULTS

All patients recovered without requiring surgical re-intervention. After IPTW adjustment, PA-MSHA treatment was significantly associated with a shorter LOS compared with conservative therapy (7.57 ± 1.49 vs. 8.86 ± 0.38). Daily clinical observations showed a visible reduction in chyle output within 24-48 h after PA-MSHA injection, the POD3/POD2 drainage reduction rate was 37% vs. 44%, not significantly different between groups after weighting, indicating a crude difference confounded by baseline drainage imbalance. Fever and neck pain were more frequent in PA-MSHA group, consistent with its inflammatory mechanism, and no severe complications occurred.

CONCLUSION

Percutaneous ultrasound-guided PA-MSHA injection may serve as a practical adjunct to conservative therapy for postoperative chyle fistula, with a significant reduction in hospitalization duration after IPTW adjustment. Further prospective studies are needed to validate its efficacy and define its optimal clinical application.