颈淋巴结清扫术后乳糜瘘的预防及处理

  目的 探讨颈清扫术后乳糜瘘的发生机制及预防处理原则。方法 河南省肿瘤医院头颈外科1983年1月至2005年1月共行各类颈清术1 750 例，出现乳糜瘘 48例、乳糜胸1例，发生率为2.8 ％，其中右侧5例，左侧44例；术前曾放、化疗者18例；治疗采用保守及手术两种方法，治疗中患者低脂饮食，保守治疗采用持续负压引流，局部加压包扎；日引流量超过500 ml经保守治疗效果不佳者手术治疗，手术采用结扎及局部喷涂创面封闭胶，带蒂肌肉瓣与创面粘合方法。结果 49例均获痊愈，保守治疗38例平均拔管时间为12.6（5～34）d；手术治疗11例平均拔管时间为7.5（3～10）d。结论 术中分别结扎胸导管及分支是主要预防措施，少量乳糜瘘保守治疗可痊愈，日引流量超过500 ml、保守治疗效果不佳者提倡尽早手术治疗，可缩短拔管时间。

Prevention and management of chylous fistula after neck dissection

Objective To explore the occurrence and prevention and the principle of management of chylous fistula after neck dissection. Methods Retrospective research on 1750 cases of neck dissection in Henan Tumor Hospital from January 1983 to January 2005. There were 48 cases chylous fistula and 1 case chylothorax. The incidence was 2.8 %. 5 cases on the right, 44 cases on the left. 18 cases had completed radiotherapy or chemotherapy before operation. Conservative methods and surgical methods were used in the treatment. Low fat food was supplied to the patients with chylous fistula. The conservative methods was local pressure, the surgical methods was applied while maximal production of chylous exceeding 500 ml a day. Results All the patients were cured finally. The conservative method was 12.6(5~34) days, the surgical method 7.5(3~10)day. Conclusion The key to prevent chylous fistula was to band the rupture of thoracis or lymphatic duct during operation. The conservative methods could be used in patients with slight and middle chylous, when the chylous exceed 500 ml a day or the conservative methods was unavailable, the surgical methods was appropriate, it could shorten the time of tube draw.