Giove Eleonora, Merlicco Domenico, Nacchiero Eleonora, Marzaioli Rinaldo
Dipartimento per le Applicazioni alla Chirurgia Delle Tecnologie Innovative U.O.C. di Chirurgia Generale Universitaria, Università degli Studi di Bari.
Ann Ital Chir. 2010 Sep-Oct;81(5):361-4.
Chyle fistula is an uncommon serious complication of neck surgery, occurring in 1-3% of radical neck dissections. An untreated chyle leak is a potentially dangerous condition that may rarely lead to hypovolemia, hyponatremia, hypochloremia, hypoproteinemia and lymphopenia. Anatomic variants of the terminal portion of the thoracic duct and suction drainage in the neck wound play a primary role in causing this kind of lesion. Poor is the literature concerning chyle fistula, due to its rarity, and mostly case reports; still debated--prevalently empiric--is the management of this disease. The Authors report a case of chyle fistula following a reintervention of cervical bilateral lymphectomy for medullary carcinoma of the thyroid in a 75 years old female. In the reported case the chyle fistula was successfully treated conservatively, in early post-operative period with a low-fat diet and total parenteral nutrition, definitely followed by sclerosant therapy. The injection of a sclerosant agent (4 g of sterile medical talc diluted in isotonic sodium chloride solution) into the supraclavicular wound bed, through the drainage tube (clamped for 2 hours), determined rapid decline in fistula output, hence obviating surgical intervention.
乳糜瘘是颈部手术一种罕见的严重并发症，在根治性颈清扫术中的发生率为1%至3%。未经治疗的乳糜漏是一种潜在的危险情况，很少会导致血容量减少、低钠血症、低氯血症、低蛋白血症和淋巴细胞减少。胸导管末端的解剖变异以及颈部伤口的负压引流在导致此类病变中起主要作用。由于乳糜瘘罕见，相关文献较少，大多为病例报告；该病的治疗仍存在争议，主要是经验性治疗。作者报告了一例75岁女性因甲状腺髓样癌行双侧颈部淋巴结清扫再次手术后发生乳糜瘘的病例。在所报告的病例中，乳糜瘘在术后早期通过低脂饮食和全胃肠外营养成功地进行了保守治疗，最终采用硬化剂治疗。通过引流管（夹闭2小时）将硬化剂（4克无菌医用滑石粉稀释于等渗氯化钠溶液中）注入锁骨上伤口床，使瘘液排出迅速减少，从而避免了手术干预。
