al-Khayat M, Kenyon G S, Fawcett H V, Powell-Tuck J
Department of Otolaryngology, Royal London Hospital, Whitechapel.
J Laryngol Otol. 1991 Dec;105(12):1052-6. doi: 10.1017/s0022215100118171.
One of the well known complications of radical neck dissection is a chylous fistula, which results from injury to the thoracic duct as it enters the left subclavian vein. Such fistulae may cause considerable increased morbidity to a patient who is already debilitated by malignancy and by the increased catabolic response to surgery. Further surgery may be appropriate for those with a high fistula output but conservative therapy is normally advocated for the remainder. Nutritional and electrolyte support for these patients is essential and poses potential problems in management. We present three such patients. One was fed parenterally and two enterally and in all cases the fistulae closed spontaneously. We examine the known physiological stimuli to chyle production and conclude that the enteral feedings of these patients with fat or an isomolar enteral feed does not, contrary to current belief, increase chyle flow or delay the healing of these fistulae.
根治性颈清扫术的一个众所周知的并发症是乳糜瘘，它是由于胸导管在进入左锁骨下静脉时受到损伤所致。这种瘘管可能会给已经因恶性肿瘤和手术导致的分解代谢反应增加而虚弱的患者带来相当大的发病率增加。对于瘘管引流量高的患者，进一步手术可能是合适的，但对于其余患者通常主张保守治疗。对这些患者进行营养和电解质支持至关重要，并且在管理上存在潜在问题。我们介绍三位这样的患者。一位通过肠外营养喂养，两位通过肠内营养喂养，所有病例的瘘管均自行闭合。我们研究了已知的刺激乳糜产生的生理因素，并得出结论，与目前的看法相反，这些患者经肠道给予脂肪或等渗肠内营养并不会增加乳糜流量或延迟这些瘘管的愈合。
