Service d'ORL, CHU, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France.
Service d'ORL, CHU, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2021 Oct;138(5):383-386. doi: 10.1016/j.anorl.2021.02.006. Epub 2021 Feb 16.
Intraoperative injury of the thoracic duct is an uncommon complication of head and neck surgery, which is difficult to manage and associated with serious consequences. We report a case of lymphorrhoea of the neck refractory to all the usual treatments that resolved in response to a treatment strategy described in thoracic and visceral surgery: use of a sympathomimetic drug, etilefrine. To our knowledge and after review of the literature, this is the first reported case of lymphorrhoea of the neck treated by etilefrine.
Our patient presented massive lymphatic fluid leakage following left neck dissection as part of the management of oropharyngeal cancer with lymph node metastases. The treatments usually proposed, such as intraoperative repair and appropriate dietary and drug management, were not effective, resulting in multiple, severe complications. After evaluation of the benefit-risk balance, treatment with etilefrine was introduced at the dosages proposed in the literature for the management of chylothorax. This treatment allowed complete resolution of the lymphatic fluid leak after one week.
Etilefrine can therefore be added to the treatment options for the management of lymphatic fluid leaks refractory to the usual treatments.
胸导管在头颈外科手术中是一种罕见的并发症，难以处理，且后果严重。我们报告了一例对所有常规治疗均无效的颈部淋巴漏病例，该病例对胸科和腹部手术中描述的一种治疗策略有反应，即使用拟交感神经药物，间羟胺。据我们所知，在回顾文献后，这是首例经间羟胺治疗的颈部淋巴漏病例。
我们的患者在接受左颈部清扫术治疗口咽癌伴淋巴结转移后出现大量淋巴液漏。通常提出的治疗方法，如术中修复和适当的饮食和药物管理，均无效，导致多种严重并发症。在评估了获益风险平衡后，采用文献中推荐的用于治疗乳糜胸的剂量引入间羟胺治疗。该治疗方案在一周后完全解决了淋巴液漏的问题。
因此，间羟胺可作为治疗对常规治疗无效的淋巴液漏的选择之一。
