37601 Department of Thoracic Surgery, Kaplan Medical Center, Rehovot, Israel.
The Hebrew University Medical School, Jerusalem, Israel.
Innovations (Phila). 2020 Sep/Oct;15(5):481-483. doi: 10.1177/1556984520935535. Epub 2020 Jul 5.
Chyle fistula is a challenging complication following neck dissection carrying a high morbidity and mortality rate. Herein we present a challenging case of successful management of high-output left-sided cervical chyle fistula with negative-pressure vacuum (VAC) therapy in a case where all conservative treatments failed. A 40-year-old man with lymphoma and supraglottic carcinoma underwent endoscopic resection and bilateral neck dissections. He developed high-output chyle fistula, nonresponsive to conservative treatments. Double-layered Vicryl mesh was placed between the sponge and the jugular vein to prevent vascular injury. Immediately after initiation of the VAC therapy, the output decreased, and completely stopped after 3 days. The VAC therapy was continued for additional 5 days to ensure complete seal of the fistula by granulation tissue, by which time the wound was primarily closed. VAC therapy seems to be a safe and effective treatment for high-output cervical chyle fistula following neck dissection, avoiding complex surgical interventions. Thoracic surgeons should be aware of this low-morbidity and potentially effective treatment modality for this challenging complication.
乳糜瘘是颈部清扫术后的一种具有高发病率和死亡率的挑战性并发症。在此，我们报告了一例成功治疗左侧高输出量颈乳糜瘘的挑战性病例，在所有保守治疗均失败的情况下，采用负压（VAC）治疗。一名 40 岁的淋巴瘤和会厌癌患者接受了内镜下切除术和双侧颈部清扫术。他发生了高输出量乳糜瘘，对保守治疗无反应。双层 Vicryl 网置于海绵和颈静脉之间，以防止血管损伤。VAC 治疗开始后，输出量立即减少，3 天后完全停止。VAC 治疗再持续 5 天，以确保肉芽组织完全封闭瘘口，此时伤口可一期闭合。VAC 治疗似乎是一种安全有效的治疗方法，可用于治疗颈部清扫术后的高输出量颈乳糜瘘，避免了复杂的手术干预。胸外科医生应该意识到这种低发病率和潜在有效的治疗方法，用于治疗这种具有挑战性的并发症。
