颈淋巴结清扫术后乳糜漏21例分析

目的：探讨预防和治疗颈淋巴结清扫术后乳糜漏的处理方法。方法回顾分析2005年1月至2014年9月该科共收治的1793例行颈淋巴结清扫术的患者，对术后出现乳糜漏患者的临床资料进行总结分析。结果21例（1．17％）颈乳糜漏患者，其中13例采用局部加压包扎加持续负压引流的常规方法治愈；5例在采用常规方法2～3 d无效的情况下联合生长抑素6mg＋0．9％生理盐水48mL，微量泵泵入2mL／h，维持24h，连用2～3d后治愈；3例再次手术治愈。结论乳糜漏最好的治疗方法在于术中的预防，局部加压包扎加持续负压引流是治疗颈淋巴结清扫术后乳糜漏的主要方法；联合生长抑素治疗可提高乳糜漏的闭合率；对持续时间较长、引流量较大、保守治疗无效的患者应采取手术的补救措施。

Analysis on 21 cases of chylous fistula after neck lymph nodes dissection

Objective To discuss the prevention and management method for chylous fistula after neck lymph node dissec‐tion .Methods Totally 1 793 cases of neck lymph node dissection in this department from January 2005 to September 2014 were retrospectively analyzed .The clinical data in the cases of chylous fistula occurred after operation were summarized .Results Twenty one cases of chylous fistula occurred ,accounting for 1 .17% ,in which 13 cases were cured by the local compressed bandaging and continuous negative pressure drainage;5 cases adopted the conventional method for 2-3 d ,but under the ineffective condition ,then they were treated by combining with somatostatin pumping (somatostatin 6 mg+0 .9% normal saline 48 mL ,2 mL/h ,lasting for 24 h ,for successive 2-3 d) and finally cured;3 cases were cured after reoperation .Conclusion Prevention is the best treatment for chylous fistulas ,local compression bandage plus continuous negative pressure drainage is the main method for treatment of chylous fistulas after neck dissection .The combined therapy with somatostatin can increase the close rate of chylous fistulas;for the patients with long persistent time ,large drainage volume and invalid conservative therapy should adopt the remedial measure of operation .