University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Faculty of Medicine, Imperial College London, and the International Centre for Recurrent Head & Neck Cancer, Royal Marsden Hospital, London, UK.
Oral Maxillofac Surg. 2024 Mar;28(1):51-62. doi: 10.1007/s10006-023-01152-8. Epub 2023 Apr 4.
Chyle leaks are a rare complication of neck surgery causing local damage, impairing healing and compromising free flaps. High output leaks can result in electrolyte imbalances and malnutrition. Nutritional management such as restricting the absorption of triglycerides is believed to reduce chyle, allowing spontaneous resolution of a leak. Dietary preparations and management can aid in reducing chyle production. There are no clear guidelines to aid nutritional decision-making in this complex scenario.
A systematic review of the literature was carried out to identify studies evaluating nutritional management of chyle leaks in patients after neck dissections.
Ten studies were identified evaluating the role of nutritional therapy in the management of patients with chyle leaks after neck dissections. The level of evidence was low. Several studies identified that low volume leaks (defined as < 1000 mls per day) often resolved by dietary management and other conservative measures. High volume leaks rarely resolved with conservative measures alone. Parenteral nutrition had an established role in this context.
There is limited evidence to guide dietary restriction and introduction of oral diet in patients with chyle leak after major head and neck surgery. Based on available evidence, local guidelines for the nutritional management of patients identified with a chyle leak were produced and adopted by the Trust and the head and neck MDT. A national database for voluntary contribution of prospective data would help to generate better quality management protocols.
乳糜漏是颈部手术后罕见的并发症，会导致局部损伤，影响愈合并使游离皮瓣受损。高流量漏液可导致电解质失衡和营养不良。人们认为，通过限制甘油三酯的吸收等营养管理可以减少乳糜液，从而使漏液自发得到解决。饮食准备和管理有助于减少乳糜液的产生。在这种复杂的情况下，没有明确的指南来帮助进行营养决策。
对文献进行系统回顾，以确定评估颈部手术后患者乳糜漏的营养管理的研究。
确定了十项评估营养疗法在颈部手术后乳糜漏患者管理中的作用的研究。证据水平较低。有几项研究发现，低流量漏液（定义为每天 < 1000 毫升）通常通过饮食管理和其他保守措施得到解决。仅通过保守措施，高流量漏液很少得到解决。肠外营养在这种情况下有明确的作用。
对于头颈部大手术后发生乳糜漏的患者，限制饮食和引入口服饮食的证据有限。根据现有证据，为该患者群体制定了局部营养管理指南，并得到了信托基金和头颈部 MDT 的采用。国家数据库用于自愿提供前瞻性数据将有助于制定出更好的管理方案。
