颈廓清术后乳糜瘘的治疗及预防

目的 回顾性分析中国医学科学院中国协和医科大学肿瘤医院头颈外科１９８３￣１９９６年底３７侧乳糜瘘的临床资料，评价乳糜瘘的治疗效果，以便合理地选择治疗方案。方法 ３７侧乳糜瘘中左３０例，右７侧。２６侧采用负压吸引、局部加压及低脂饮食的保守治疗，其中２侧为促进乳糜瘘的愈合，同时给予皮瓣下注入５０％葡萄糖；７侧手术缝扎；４侧局部切开填塞碘仿或无菌纱布或纱条。结果：８６％（３２／３７）的乳糜瘘发生于手术后

Prevention and management of chylous fistula after neck dissection]

OBJECTIVE: To evaluate the effect of treatment for chylous fistulas after neck dissection, as a means of reasonable option of therapeutic measures. METHODS: Of 37 chylous fistulas, 30 were left-sided and 7 were right-sided. Conservative therapy which included closed-wound drainage and local pressure dressing and/or low-fat nutritional support was employed in 26 cases, and 50% glucose was injected into the neck basic wound bed in 2 cases, to promoto the chylous fistula healing up. Operative ligation was performed in 7 cases. Open-wound and packing in 4 cases. RESULTS: Eighty-six percent chylous fistula occured from 1 to 3 postoperative days. Of 26 chylous fistulas with conservative management, 15 cases were successfully treated, the mean duration for healing was 9.7 (4-30) days, the remaining 11 cases failed to had and were further treated surgically. Seven cases with operative ligation were successful, and the other 4 cases with open-wound and packing had delayed healing, the mean duration was 8.5 (7-10) days. CONCLUSION: The majority of patients with chylous fistulas could be treated reasonablly without increasing the hospital days. The conservative therapy should be employed in cases with a maximal production of chyle below 500 ml a day. Operative ligation should be done early in cases with a maximal production exceeding 500 ml a day and with conservative treatment failure for a few days. The open-wound and packing should be used in chylous fistulas persisting for more then 7 days.