颈部手术后乳糜漏的保守治疗

Conservative therapy in the treatment of cervical chylous leakage

目的评估颈部手术后乳糜漏并发症的综合保守治疗的效果。方法回顾性分析1992年6月至2008年6月共收治的39例颈部手术后乳糜漏患者。分别采用饮食控制（调整饮食为高热量、高蛋白、低脂肪饮食，食物中仅含中链甘油三酯）；静脉营养支持；补充水、电解质等对症治疗；局部加压包扎；持续强负压（-50～-80kPa）吸引引流乳糜；生长抑素类似物的应用等综合保守治疗，通过观察术后患者乳糜引流量的变化评估疗效。结果乳糜漏均发生在颈部手术后2—5d，39例患者中高流量（≥500ha／d）7例，每日乳糜引流量最高达1440ml，均通过综合保守治疗痊愈，愈合时间3～12d，平均（6．2±2．3）d（x^-±s）。无再手术患者，未发生切口积液、感染等并发症。随访4个月～11年无复发病例。结论综合保守治疗是处理颈部手术后乳糜漏并发症安全有效的方法。

Objective To explore and evaluate the combined conservative managements in the treatment of cervical chylous leakage. Methods Thirty nine cases of cervical ehylous leakage from Jun 1992 to Jun 2008 were retrospectively analyzed in this hospital. All of the 39 cases were cured by treating with conservative individualized therapy, including the applying of diet with high calory, high protein and low fat and fatty food should only contains medium-chain triglycerides, total parenteral nutrition, keep the balance of hydrogen and electrolyte and correct hypoproteinemia, local pressure dressing, high persistent vacuum drainage （ - 50 - - 80 kPa） and/or somatostatin analogue. Results All the cases of chylous leakage happened 2nd to 5th days after the operation. Among the 39 cases, 7 were high flow （ drainage ≥500 ml/d） chylous leakage, the amount of drainage reached as high as 1440 ml per day. The time of chylous leakage closure was 3 -12 days, and the mean time was 7 days. No one experienced re-operation, wound hydrops or wound infection. Conclusions The conservative individualized therapy may play a key role in the treatment of cervical chylous leakage.