Kumar S, Kumar A, Pawar D K
Departments of Surgical disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India.
J Postgrad Med. 2004 Jan-Mar;50(1):57-9.
Thoracic duct injury is a rare but serious complication following chest surgeries and major neck dissections. Clinically, it can present as cervical chylous fistula, chylothorax or chylopericardium. Without treatment, the mortality is up to 50% and thus, early aggressive therapy is indicated. Traditional conservative management includes low-fat diet, parenteral nutrition, careful monitoring of fluid and electrolytes, and drainage of the neck wound or chylothorax. Patients with failed conservative management require definitive treatment in the form of ligation of the thoracic duct, which has traditionally been done by thoracotomy. The advent of Video-Assisted-Thoracoscopic-Surgery (VATS) over the last decade has changed the approach towards the management of numerous chest diseases. Thoracoscopic ligation of the thoracic duct has also been reported. We report herein a case of postoperative cervical chylous fistula managed successfully by VATS thoracic duct ligation and present a systematic analysis of the English literature to highlight the current trends in the management of thoracic duct injury.
胸导管损伤是胸部手术和颈部大清扫术后一种罕见但严重的并发症。临床上，它可表现为颈部乳糜瘘、乳糜胸或乳糜心包。若不治疗，死亡率高达50%，因此，需要早期积极治疗。传统的保守治疗包括低脂饮食、肠外营养、仔细监测液体和电解质，以及引流颈部伤口或乳糜胸。保守治疗失败的患者需要以结扎胸导管的形式进行确定性治疗，传统上是通过开胸手术完成的。在过去十年中，电视辅助胸腔镜手术（VATS）的出现改变了众多胸部疾病的治疗方法。也有报道采用胸腔镜结扎胸导管。我们在此报告一例通过VATS胸导管结扎成功治疗的术后颈部乳糜瘘病例，并对英文文献进行系统分析，以突出胸导管损伤治疗的当前趋势。
