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右侧颈部清扫术后乳糜漏的处理:罕见病例并文献复习(病例报告)。

Management of chyle leak in right side neck dissection: a rare case and review of literature (a case report).

机构信息

Department of Dentistry, Dr. Panjabrao Deshmukh Memorial Medical College, Amravati, India.

Department of Facio-Maxillary Surgery, Sanjay Gandhi Institute of Trauma and Orthopeadics, Bangalore, Karnataka, India.

出版信息

Pan Afr Med J. 2021 Dec 7;40:209. doi: 10.11604/pamj.2021.40.209.30496. eCollection 2021.

Abstract

Chyle leak is a well-recognized iatrogenic thoracic duct injury but a rare and serious complication of head and neck surgery affecting 1-2.5% of head and neck surgery dissections. It is potentially a life-threatening condition and management may be problematic and prolonged. Here we presented a rare case report of right sided chyle leak with its surgical management and review of literature. A 56-year-old patient with a complain of non-healing ulcer in the right buccal vestibule in the last 1-2 months reported to the outpatient department (OPD). After complete preoperative profile and counseling patient's consent was taken and wide local excision of lesion was done with bite composite resection with right hemimandibulectomy and maxillary alveolectomy till pterygoid plates, with right side selective neck dissection, level I-III followed by reconstruction with right side pectoralis major myofascial flap. Then the patient was on 5 days octreotide therapy. Regular post-operative follow-up was taken and no leak was noted further. In case of a chyle leak early diagnosis and aggressive treatment is essential to avoid local and systemic complications that prolong hospitalization.

摘要

乳糜漏是一种公认的医源性胸导管损伤,但在头颈部手术中较为罕见且严重,影响 1-2.5%的头颈部手术解剖。这是一种潜在的危及生命的情况,治疗可能存在问题且耗时较长。在此,我们报告一例右侧乳糜漏的罕见病例,并对其进行手术治疗和文献复习。一位 56 岁的患者因右侧颊部前庭处持续 1-2 个月的未愈合溃疡而到门诊就诊。在完成全面的术前检查和咨询后,征得患者同意,进行了广泛的局部切除,包括病变部位、部分下颌骨、上颌牙槽骨至翼状板,同时进行右侧选择性颈清扫术(I-III 级),然后用右侧胸大肌肌筋膜瓣进行重建。术后患者接受了 5 天的奥曲肽治疗。定期进行术后随访,未发现进一步漏液。一旦发生乳糜漏,早期诊断和积极治疗至关重要,以避免局部和全身并发症导致住院时间延长。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/29c1/8783314/8ab372616cdd/PAMJ-40-209-g001.jpg

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