de Gier H H, Balm A J, Bruning P F, Gregor R T, Hilgers F J
Department of Otolaryngology/Head & Neck surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Hospital), Amsterdam, The Netherlands.
Head Neck. 1996 Jul-Aug;18(4):347-51. doi: 10.1002/(SICI)1097-0347(199607/08)18:4<347::AID-HED6>3.0.CO;2-Y.
Chylous leakage is an uncommon complication after neck dissection for which several treatment modalities have been described in literature. It occurs in 1% to 2.5% of radical neck dissections, with the majority (75% to 92%) being on the left side. In a consecutive series of patients, we investigated the effect of a systematic approach to the complication.
Over a period of 5 years, the drain production of 221 patients who underwent a neck dissection was analyzed. One hundred thirty-two right-sided and 139 left-sided neck dissections were performed. In 11 patients a chyle fistula occurred, 1 right-sided and 10 lift-sided. In all cases closed vacuum suction drainage was continued and dietary modifications (medium-chain triglycerides [MCT]/Peptison nasogastric tube feeding [PNTF]) were made.
In 5 patients dietary modifications were sufficient to stop the leak. In the other 6 patients total parenteral nutrition via the subclavian vein (TPN) was started. In 2 cases with a severe intractable hypoalbuminemia, surgical intervention was necessary. The leak was closed by a pectoralis major muscle flap transfer, after local application of fibrin sealant (Tissucol).
Chylous leakage is a controllable complication after neck dissection for which is most cases a stepwise conservative approach consisting of dietary modifications, maintaining closed vacuum suction drainage, seems to be sufficient. Hematologic and serum values should be monitored very carefully and corrected appropriately. To initiate planned postoperative radiotherapy in a timely fashion, the conservative treatment should be limited to about 30 days.
乳糜漏是颈部清扫术后一种罕见的并发症，文献中已描述了多种治疗方式。它在根治性颈部清扫术中的发生率为1%至2.5%，大多数（75%至92%）发生在左侧。在一系列连续的患者中，我们研究了对该并发症采用系统方法的效果。
在5年的时间里，分析了221例行颈部清扫术患者的引流液情况。其中右侧颈部清扫术132例，左侧颈部清扫术139例。11例患者发生了乳糜瘘，右侧1例，左侧10例。所有病例均持续进行封闭式负压吸引引流，并进行饮食调整（中链甘油三酯[MCT]/百普素鼻饲管喂养[PNTF]）。
5例患者通过饮食调整足以停止渗漏。另外6例患者开始经锁骨下静脉进行全胃肠外营养（TPN）。2例严重顽固性低蛋白血症患者需要手术干预。在局部应用纤维蛋白粘合剂（组织胶）后，通过胸大肌肌瓣转移封闭了渗漏。
乳糜漏是颈部清扫术后一种可控的并发症，在大多数情况下，由饮食调整、维持封闭式负压吸引引流组成的逐步保守方法似乎就足够了。应非常仔细地监测血液学和血清值并进行适当纠正。为了及时开始计划好的术后放疗，保守治疗应限制在约30天。
