ENT Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
Cancer sciences, University of Southampton, Southampton, UK.
Clin Otolaryngol. 2021 May;46(3):474-484. doi: 10.1111/coa.13700. Epub 2021 Jan 22.
Chylous fistula following neck surgery is a rare, but significant complication. Currently, there is no standardised treatment, which may comprise pressure dressings, oral dietary modification (ODM), surgery or a combination of such measures. Octreotide is a somatostatin analogue that has gained popularity in the management of cervical chyle leaks. The effectiveness of octreotide compared with ODM is unclear. We provide a comprehensive, systematic review of the literature pertaining to the management of chylous fistulae, comparing both treatment strategies.
The bibliographic databases MEDLINE, Cochrane, PubMed, EMBASE and Google Scholar were searched from inception to October 2019. Search terms included (chyle [title/abstract]) OR (chylous [title/abstract]) AND (fistula [title/abstract]) OR (fistulae [title/abstract]) OR (leak [title/abstract]) AND (neck [title/abstract]) OR (dissection [title/abstract]). The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Risk of bias was assessed using guidelines from the Joanna Briggs Institute. Outcome measures included the proportion of chylous fistulae that spontaneously resolved without the need for surgery and time taken until resolution, for both DM and octreotide, respectively.
The primary search identified 20 articles for review, comprising 313 patients. Two studies were suitable for pooled analysis. There was no statistically significant difference in the time taken for chylous fistula to resolve between groups (octreotide 10.0 days; ODM 12.0 days; P = .38). The overall rate of resolution was 89.6% and 81.5%, respectively (P = .25). Surgery was highly effective in cases failing to resolve following intervention with either method (96% [53/55] patients).
The use of octreotide for chylous fistula following neck dissection surgery is associated with a high rate of spontaneous resolution. However, significant heterogeneity, bias and concurrent use of ODM/TPN for patients in studies investigating octreotide precludes universal recommendation at this time. Further research in the form of randomised controlled trials is required to establish an independent treatment effect.
颈部手术后乳糜瘘是一种罕见但严重的并发症。目前，尚无标准化的治疗方法，可能包括加压包扎、口服饮食调整（ODM）、手术或这些措施的联合应用。奥曲肽是一种生长抑素类似物，在治疗颈部乳糜漏方面已得到广泛应用。奥曲肽与 ODM 相比的疗效尚不清楚。我们对文献进行了全面、系统的回顾，比较了这两种治疗策略。
从建库到 2019 年 10 月，检索 MEDLINE、Cochrane、PubMed、EMBASE 和 Google Scholar 等文献数据库。检索词包括（chyle [标题/摘要]）或（chylous [标题/摘要]）和（瘘管 [标题/摘要]）或（瘘管 [标题/摘要]）或（漏出 [标题/摘要]）和（颈部 [标题/摘要]）或（解剖 [标题/摘要]）。本研究遵循《系统评价和荟萃分析的首选报告项目》（PRISMA）指南进行。使用 Joanna Briggs 研究所的指南评估偏倚风险。结果测量包括分别使用 DM 和奥曲肽时，无需手术即可自行解决的乳糜瘘的比例以及解决所需的时间。
初步搜索共确定 20 篇文章进行综述，共纳入 313 例患者。有 2 项研究适合进行汇总分析。两组乳糜瘘的愈合时间无统计学差异（奥曲肽 10.0 天；ODM 12.0 天；P=0.38）。总体愈合率分别为 89.6%和 81.5%（P=0.25）。对于干预后未解决的病例，手术的效果非常显著（96%[53/55]患者）。
奥曲肽治疗颈部淋巴结清扫术后乳糜瘘可自行愈合，但由于研究中使用奥曲肽的患者存在显著的异质性、偏倚和同时使用 ODM/TPN，目前不建议普遍推荐。需要进一步的随机对照试验研究来确定其独立的治疗效果。
