Spiro J D, Spiro R H, Strong E W
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.
Laryngoscope. 1990 Jul;100(7):771-4. doi: 10.1288/00005537-199007000-00014.
Over a recent 4-year period, 823 neck dissections that included the lower jugular lymph nodes were performed. Of the 823, 14 (1.9%) patients developed chyle fistulas. Two other patients developed fistulas, one after undergoing a gastric transposition, and the other after a scalene node biopsy. All 16 patients were initially managed conservatively with closed-wound drainage and low-fat nutritional support; this was successful in only 4 patients, 3 of whom had peak 24-hour chyle drainage of less than 600 cc. The remaining 10 patients required open-wound management, which included operative ligation in 4 instances. Continued conservative treatment with an open neck wound resulted in significant additional hospitalization. Our experience indicates that closed-wound management of a chyle fistula is likely to fail when peak 24-hour fistula output exceeds 600 cc. Considering the cost and morbidity of conservative treatment, early reoperation may be appropriate in those patients with high fistula output.
在最近4年期间，共进行了823例包括下颈淋巴结的颈部清扫术。在这823例患者中，14例（1.9%）发生了乳糜瘘。另外2例患者也发生了瘘，1例在接受胃移位术后发生，另1例在斜角肌淋巴结活检后发生。所有16例患者最初均采用封闭伤口引流和低脂营养支持进行保守治疗；仅4例治疗成功，其中3例24小时乳糜引流量峰值小于600 cc。其余10例患者需要开放伤口处理，其中4例进行了手术结扎。颈部伤口开放的情况下继续进行保守治疗导致住院时间显著延长。我们的经验表明，当24小时瘘管引流量峰值超过600 cc时，乳糜瘘的封闭伤口处理很可能失败。考虑到保守治疗的成本和发病率，对于瘘管引流量高的患者，早期再次手术可能是合适的。
