Gunnlaugsson Chad B, Iannettoni Mark D, Yu Bo, Chepeha Douglas B, Teknos Theodoros N
Department of Otolaryngology, University of Michigan, Ann Arbor, MI 48109-0312, USA.
ORL J Otorhinolaryngol Relat Spec. 2004;66(3):148-54. doi: 10.1159/000079335.
To document the treatment of refractory chyle leaks using thoracoscopic thoracic duct ligation and provide systematic guidelines to manage chyle leaks.
The medical records of 2 patients with chyle leaks are reviewed, followed by a review of the literature on chyle leaks and their thoracoscopic management.
Initial treatment of chyle fistula is aimed at conservative medical management. Persistent high-output fistulas (>500 cm(3)) should be considered for neck reexploration as conservative management is likely to fail. Thoracoscopic thoracic duct ligation provides a safe and efficient means of treating chyle leaks refractory to repeated surgical and medical intervention. It should also be considered as a primary surgical intervention for patients with: (1) chyle output exceeding 500 cm(3)/day where prior intraoperative attempts at ligation have failed, (2) severe metabolic and nutritional complications, (3) coexisting chylothorax with respiratory compromise, and (4) low-output fistulas (<500 cm(3)/day) of long duration (>14 days).
记录使用胸腔镜胸导管结扎术治疗难治性乳糜漏的情况，并提供管理乳糜漏的系统指南。
回顾了2例乳糜漏患者的病历，随后对有关乳糜漏及其胸腔镜治疗的文献进行了回顾。
乳糜瘘的初始治疗旨在进行保守的药物治疗。对于持续的高流量瘘（>500立方厘米），由于保守治疗可能失败，应考虑进行颈部再次探查。胸腔镜胸导管结扎术为治疗经反复手术和药物干预仍难治的乳糜漏提供了一种安全有效的方法。对于以下患者，也应将其视为主要的手术干预措施：（1）乳糜排出量超过500立方厘米/天且先前术中结扎尝试失败的患者；（2）严重的代谢和营养并发症患者；（3）并存乳糜胸且伴有呼吸功能不全的患者；（4）持续时间长（>14天）的低流量瘘（<500立方厘米/天）患者。
