van Goor Arnoud T, Kröger Robert, Klomp Houke M, de Jong Marianne A A, van den Brekel Michiel W M, Balm Alfons J M
Department of Head and Neck Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Head Neck. 2007 Nov;29(11):1017-23. doi: 10.1002/hed.20624.
Chylous fistula occurring after head and neck or thoracic surgery is an uncommon but well-described complication, with a reported incidence of 1% to 2.5%. Conservative management can be successful and consists of dietary measures combined with suction drainage. This article reports on percutaneous embolization of the thoracic duct through catheterization of the retroperitoneal lymph vessels.
Two patients, in whom conservative management for cervical chylous fistula failed, underwent lymphangiography with opacification of the thoracic duct, followed by radioguided catheterization and embolization.
Embolization was successful in both patients. In 1 patient the procedure had to be repeated once to stop the chylous drainage.
Radioguided percutaneous catheterization and embolization of the retroperitoneal lymph vessels offers an excellent treatment option for patients with persistent chylous fistulas after failure of conservative management. We revised our stepwise management protocol (de Gier, Head Neck 1996; 18:347-351) and now consider this procedure as the secondary intervention step.
头颈部或胸部手术后发生的乳糜瘘是一种少见但已有充分描述的并发症，报道的发生率为1%至2.5%。保守治疗可能成功，包括饮食措施联合负压引流。本文报道了通过经皮穿刺经腹膜后淋巴管插管对胸导管进行栓塞。
两名颈段乳糜瘘保守治疗失败的患者接受了淋巴管造影，使胸导管显影，随后进行放射性引导下的插管和栓塞。
两名患者的栓塞均成功。1例患者该操作不得不重复一次以停止乳糜引流。
放射性引导下经皮经腹膜后淋巴管插管和栓塞为保守治疗失败的持续性乳糜瘘患者提供了一种极佳的治疗选择。我们修订了我们的逐步治疗方案（de Gier，《头颈外科》1996年；18：347 - 351），现在将该操作视为二级干预步骤。
