Department of Surgical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India.
Clin Breast Cancer. 2011 Oct;11(5):320-4. doi: 10.1016/j.clbc.2011.04.003. Epub 2011 May 13.
Chylous fistula is a known complication in procedures such as neck dissection and aneurysm surgery. However chyle leak that develops after axillary dissection is a rare phenomenon. In this study we have evaluated the incidence, possible cause, and management of chylous fistula that develops after radical breast cancer surgeries.
Chylous fistula developed in 6 of 1863 patients who underwent axillary dissection. Their records were analyzed in terms of clinical profile and management. A review of the literature regarding the thoracic duct anatomy at its termination was carried out and a hypothesis about the possible cause of chylous leak was suggested.
All 6 patients had procedures on the left side and had varied clinical stages and profiles. The chyle discharge was detected intraoperatively during the primary surgical procedure in 2 patients. The other 4 patients presented with chyle in their drains postoperatively. One patient did not respond to conservative management and underwent reexploration to seal the leak. Injury to the thoracic duct or its aberrant branches is apparently not the cause of chylous fistula in the axilla. The injury to the left subclavian duct or its tributary, which drains aberrantly into the thoracic duct through a valveless junction has been hypothesized to be the source of chyle in the axilla.
Chylous fistula is very unusual after axillary dissection. Most of the chyle leaks in the axilla are manageable through conservative methods; surgical intervention is required rarely in special situations. Injury to the left subclavian duct or its tributary is the possible cause.
乳糜瘘是颈部清扫术和动脉瘤手术等操作中已知的并发症。然而，腋窝清扫术后发生乳糜漏是一种罕见现象。在本研究中，我们评估了腋窝清扫术后发生的乳糜瘘的发生率、可能的原因和处理方法。
1863 例接受腋窝清扫术的患者中有 6 例发生乳糜瘘。分析了他们的临床特征和处理方法。对胸导管在其末端的解剖结构进行了文献复习，并提出了一种关于乳糜漏可能原因的假说。
所有 6 例患者均行左侧手术，且具有不同的临床分期和特征。2 例患者在初次手术过程中术中发现乳糜液漏出。另外 4 例患者术后引流管中出现乳糜。1 例患者对保守治疗无反应，行再次探查以封闭漏口。胸导管或其异常分支的损伤显然不是腋窝乳糜瘘的原因。左侧锁骨下导管或其异常分支的损伤，通过无瓣膜交界处异常引流至胸导管，被假设为腋窝乳糜的来源。
腋窝清扫术后发生乳糜瘘非常罕见。大多数腋窝乳糜漏可通过保守方法治疗；在特殊情况下，很少需要手术干预。左侧锁骨下导管或其分支的损伤可能是其原因。
