颈淋巴结清扫术后乳糜瘘的防治

目的：总结120例颈淋巴结清扫术发生6例乳糜瘘或淋巴管漏的原因及处理方法。方法：120例颈淋巴结清扫术中，功能性颈淋巴结清扫术32例，根治性颈淋巴结清扫术98例。术后发生乳糜瘘6例，行局部加压包扎并引流，1例治疗未果行二次手术缝扎，结果：发生乳糜瘘者均为根治性颈清扫术，其中左侧手术43例，发生乳糜瘘4例(8．386％)，右侧55例，发生2例(3．636％)，平均每日引流量20～100ml，5例于术后4～7d止漏，行二次手术(缝扎术)1例，术后19日止漏。9例乳糜瘘或淋巴管漏均治愈。结论：左侧根治性颈淋巴结清扫术后乳糜瘘发生率明显高于右侧，与两侧不同的解剖特点有关．术者对解剖的熟悉程度和手术操作的轻柔仔细是预防发生乳糜瘘的关键，乳糜瘘的处理以局部加压为主，难愈者再行二期手术。

The prevention and cure of chylorrhea after neck dissection

Objective:To summarize the occurrence and management of chylorrhea after neck dissection. Method: There were 6 patients with chylorrhea in 120 undergone neck dissection. Pressure dressing and drainage was given in all the patients. One of them accepted transfixion. Result: All the cases were happened after radical neck dissection, Four cases among 43 left-sideness (8.386%) and 2 in right-sideness (3.636%). Drainage flow is 25ml to 100ml per day. Five of them healed in 4-7 days after the operation, One in 19 days. Conclusion: The incidence of chylorrhea after left neck dissection (8.386%) is much severity then the right side (3.636%). It is related to the local anatomic. Operator should know better about the anatomy of neck dissection. It shows that local pressure dressing and drainage is effective. In the refractory chylorrheas, the transfixion is necessary.