颈清扫术后颈淋巴瘘的处理方法

目的探讨颈淋巴结清扫术(简称颈清扫术)后颈淋巴瘘的发病机制和处理方法。方法对我科1997年6月～2010年12月行各类颈清扫术患者323例(其中同时双侧颈清扫术18例)进行分析,术后总计9例发生颈淋巴瘘,总发生率为2.9%(9/305),其中左侧颈淋巴瘘发生率为2.6%(8/305),右侧发生率为0.3%(1/305),术前曾行放、化疗者各1例。其中4例日淋巴液引流量<200 ml者采用负压吸引、加压包扎、低脂饮食等保守治疗,3例日淋巴液引流量<500 ml而>200 ml者采用负压吸引、加压包扎和禁食、水等保守治疗(静脉营养支持),2例日淋巴液引流量>500 ml者采用手术治疗:缝扎胸导管或淋巴管瘘口,必要时利用临近肌肉和筋膜等组织填塞、固定。结果保守治疗的7例患者均痊愈,平均愈合时间为8.7(6～10)d,2例手术治疗均治愈,平均愈合时间8(8)d。结论颈清扫术后颈淋巴瘘经过合理治疗是完全可以治愈的。对于日引流量<500 ml的可采用负压吸引、加压包扎、低脂饮食甚至禁食、水等保守治疗,对于日引流量>500 ml的应尽快手术治疗,均可取得较好疗效。

Management of lymphatic leakage after neck dissection

OBJECTIVE To explore the causes and management of lymphatic leakage after neck dissection.METHODS The clinical data of 323 cases underwent neck dissection from June 1997 to December 2010 in our department（including 18 cases with bilateral neck dissection）were retrospectively studied.The rate of lymphatic leakage after operation was 2.9%（9/305）,and the rate of left side was 2.6%（8/305）,right side was 0.3%（1/305）.Conservative therapy which included closed wound drainage,local pressure dressing and low-fat nutritional support（or fasting）was employed in 7 cases.Operative ligation was performed in 2 cases.RESULTS Seven cases with conservative therapy were cured successfully,the mean duration for healing was 8.7（6～10）days.Two cases with operative ligation were also cured successfully.The mean duration was 8（8） days.CONCLUSION The majority of patients with lymphatic leakage could be cured with proper management.The conservative therapy should be employed in case with a maximal production of lymphatic leakage 500 ml a day.Operative ligation should be done early in cases with a maximal production over 500 ml a day.