Matani Sara, Pierce J Rush
University of New Mexico School of Medicine, Albuquerque, NM, USA.
J Investig Med High Impact Case Rep. 2015 Apr 22;3(2):2324709615583877. doi: 10.1177/2324709615583877. eCollection 2015 Apr-Jun.
We report a case of bilateral chylothorax without evidence of chylous fistula in a 62-year-old man following total laryngectomy and bilateral selective neck dissection for laryngeal cancer. Chylous fistulae, a well-known complication of neck dissection, occurs following 1% to 2% of these surgeries. On rare occasions, the chyle leak may communicate with the pleural space, resulting in chylothorax. This is a rare but potentially life-threatening complication. Bilateral chylothorax following neck dissection is even rarer, with less than 25 cases reported in the literature. Early diagnosis is essential to prevent complications. Physicians should have a high index of suspicion, especially when the postoperative effusions do not respond to diuretics. Though no evidence-based treatment guidelines exist, expert opinion recommends conservative management as first-line therapy. Our patient was effectively treated by conservative management. We postulate a mechanism whereby bilateral chylothorax occurred in our patient without a chylous fistula.
我们报告了一例62岁男性患者，在因喉癌接受全喉切除术和双侧选择性颈部清扫术后出现双侧乳糜胸，但未发现乳糜瘘。乳糜瘘是颈部清扫术的一种常见并发症，在这些手术中发生率为1%至2%。在极少数情况下，乳糜漏可能与胸膜腔相通，导致乳糜胸。这是一种罕见但可能危及生命的并发症。颈部清扫术后双侧乳糜胸更为罕见，文献报道不足25例。早期诊断对于预防并发症至关重要。医生应保持高度警惕，尤其是当术后积液对利尿剂无反应时。尽管尚无基于证据的治疗指南，但专家意见建议将保守治疗作为一线治疗方法。我们的患者通过保守治疗得到了有效治疗。我们推测了一种机制，解释了我们的患者在没有乳糜瘘的情况下发生双侧乳糜胸的原因。
