Dhiwakar Muthuswamy, Nambi G I, Ramanikanth T V
Otolaryngology-Head and Neck Surgery, Comprehensive Cancer Center, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, 641 014, India,
Eur Arch Otorhinolaryngol. 2014 Mar;271(3):561-5. doi: 10.1007/s00405-013-2534-9. Epub 2013 May 8.
Chylous fistula following neck dissection is difficult to treat. We hypothesized that timely removal of the suction drain followed by daily aspiration might aid in resolution of the condition. The study model is prospective cohort study. Out of 170 consecutive neck dissections, 7 (4 %) developed chylous fistula postoperatively. Retaining the suction drain was associated with resolution of the fistula in only one case. The remaining six had peak 24 h outputs between 85 and 675 ml that showed no significant fall despite maximal conservative treatment. Suction drain removal followed by daily needle aspiration however led to cessation of the fistula in all six cases. No patient required surgical re-exploration. Drain removal was associated with a significant fall in the volume of chylous output (p = 0.002). In selected cases of low output chylous fistula, suction drain removal and daily needle aspiration is an effective treatment option.
颈部清扫术后的乳糜瘘难以治疗。我们假设及时拔除负压引流管并每日进行抽吸可能有助于病情的缓解。该研究模型为前瞻性队列研究。在连续170例颈部清扫术中，有7例（4%）术后发生乳糜瘘。保留负压引流管仅使1例瘘口得到愈合。其余6例患者24小时乳糜液引流量峰值在85至675毫升之间，尽管采取了最大程度的保守治疗，引流量仍无显著下降。然而，拔除负压引流管并每日进行针吸后，所有6例患者的瘘口均停止渗漏。无一例患者需要再次手术探查。拔除引流管后乳糜液引流量显著下降（p = 0.002）。在部分低流量乳糜瘘病例中，拔除负压引流管并每日进行针吸是一种有效的治疗选择。
