Lucente F E, Diktaban T, Lawson W, Biller H F
Otolaryngol Head Neck Surg. 1981 Jul-Aug;89(4):575-8. doi: 10.1177/019459988108900413.
Chyle fistula is a potentially devastating phenomenon that results from violation of the thoracic duct or right lymphatic duct in the neck, most commonly during radical neck dissection. It may impair nutrition, compromise and delay wound healing, and prolong hospitalization. In view of the morbidity produced by chyle leak discovered postoperatively and the lack of success of its management by aggressive surgical techniques, we have employed a different protocol for the past six years. It is based on careful intraoperative inspection of the neck for possibly chyle fistula, minimal but specific surgical handling of the damaged duct, and a postoperative nutritional program designed to reduce chyle formation and facilitate spontaneous closure. The nutritional element involves the use of medium chain triglycerides (MCT) that are easily ingested, rapidly absorbed, and readily metabolized directly into the portal venous system, bypassing the thoracic duct lymphatic system. During a four-year period, 1976 to 1980, 574 radical neck dissections were performed with only six chyle fistulas being detected postoperatively. All have been successfully treated by the protocol with no patients requiring reexploration. There have been no deaths owing to chyle fistula and no complications or side effects from the use of medium chain triglycerides.
乳糜瘘是一种潜在的严重现象，多因颈部胸导管或右淋巴管受损所致，最常见于根治性颈清扫术中。它可能影响营养状况，妨碍并延迟伤口愈合，延长住院时间。鉴于术后发现乳糜漏所产生的发病率以及积极手术治疗方法的失败，在过去六年中我们采用了一种不同的方案。该方案基于术中仔细检查颈部是否可能存在乳糜瘘，对受损导管进行最小化但特定的手术处理，以及术后营养计划以减少乳糜形成并促进自行闭合。营养方面涉及使用中链甘油三酯（MCT），其易于摄取、快速吸收，并可直接迅速代谢进入门静脉系统，绕过胸导管淋巴系统。在1976年至1980年的四年期间，共进行了574例根治性颈清扫术，术后仅发现6例乳糜瘘。所有病例均通过该方案成功治疗，无患者需要再次探查。没有因乳糜瘘导致的死亡，使用中链甘油三酯也没有并发症或副作用。
