Department of Otolaryngology-Head and Neck Surgery, Auckland City Hospital, Auckland, New Zealand.
Otolaryngol Head Neck Surg. 2007 Apr;136(4 Suppl):S50-3. doi: 10.1016/j.otohns.2006.11.017.
Chylous fistula is an uncommon complication of lower neck dissection. If untreated, it can lead to severe electrolyte disturbance, fluid, and protein loss and ultimately threaten skin flaps and vital structures. Conservative management aims to decrease chyle volume by replacing long-chain triglycerides (LCTs) with medium-chain triglycerides in the diet or by total parenteral nutrition.
In 2001, Greenlane Head and Neck unit conducted a prospective 2-year study of all patients with chylous fistula.
Eleven patients developed chylous fistula in the period between 2001 and 2003, out of 210 neck dissections. All cases were managed conservatively. The mean time to diagnosis was 1.5 days (1-4), time to closure was 8.1 days (4-26), and mean duration of treatment was 11.5 days (4-35).
We would recommend conservative management of chylous fistulae with a low LCT diet using Monogen alone to be continued only for the duration of the fistula.
乳糜瘘是颈部低位清扫术的一种罕见并发症。如果不加以治疗，它可能导致严重的电解质紊乱、液体和蛋白质流失，并最终威胁皮瓣和重要结构。保守治疗旨在通过在饮食中用中链甘油三酯（MCT）代替长链甘油三酯（LCT），或通过全胃肠外营养来减少乳糜量。
2001 年，格林兰头颈外科单位对所有患有乳糜瘘的患者进行了为期 2 年的前瞻性研究。
2001 年至 2003 年期间，在 210 例颈部清扫术中，有 11 例患者出现乳糜瘘。所有病例均保守治疗。诊断的平均时间为 1.5 天（1-4 天），闭合时间为 8.1 天（4-26 天），治疗的平均持续时间为 11.5 天（4-35 天）。
我们建议采用低 LCT 饮食联合 Monogen 进行保守治疗，仅在瘘管持续期间使用。
