Langford R J, Daudia A T, Malins T J
Department of Oral and Maxillofacial Surgery, Royal Shrewsbury Hospitals Trust, UK.
J Craniomaxillofac Surg. 1999 Apr;27(2):100-4. doi: 10.1016/s1010-5182(99)80021-3.
Chylous fistulae are uncommon but serious complications of neck surgery, occurring with an incidence of 1-3% after radical neck dissection. The majority occur on the left side (75-92%) and are due to damage to the terminal segment of the thoracic duct as it drains into the great veins of the neck in the region of the venous angle. The risk of trauma to the terminal thoracic duct may be influenced by anatomical variations. The macroscopic arrangement of the termination of the thoracic duct in the left neck was examined in 24 UK cadavers. Twenty-one ducts terminated as a single vessel, two ducts showed a bifid termination and one duct had three terminal branches. The precise site of termination was variable. Five thoracic ducts showed branching and reanastamosing patterns prior to their termination, irrespective of the number of terminal branches. Subsidiary cervical lymph trunks were identified in four dissections. These variations are described and their relevance to surgery involving the left side of the neck is discussed.
乳糜瘘是颈部手术中罕见但严重的并发症，在根治性颈清扫术后的发生率为1% - 3%。大多数发生在左侧（75% - 92%），是由于胸导管末段在静脉角区域汇入颈部大静脉时受损所致。胸导管末段受创伤的风险可能受解剖变异影响。对24具英国尸体的左颈部胸导管末端的宏观排列进行了检查。21条导管以单一血管形式终止，2条导管呈双歧状终止，1条导管有3个末端分支。确切的终止部位各不相同。5条胸导管在终止前呈现分支和再吻合模式，与末端分支数量无关。在4次解剖中发现了颈副淋巴干。描述了这些变异，并讨论了它们与涉及左颈部手术的相关性。
