颈廓清术后乳糜瘘的治疗及预防

Prevention and management of chylous fistula after neck dissection

目的回顾性分析中国医学科学院中国协和医科大学肿瘤医院头颈外科１９８３～１９９６年底３７侧乳糜瘘的临床资料，评价乳糜瘘的治疗效果，以便合理地选择治疗方案。方法３７侧乳糜瘘中左３０侧，右７侧。２６侧采用负压吸引、局部加压及低脂饮食的保守治疗，其中２侧为促进乳糜瘘的愈合，同时给予皮瓣下注入５０％葡萄糖；７侧手术缝扎；４侧局部切开填塞碘仿或无菌纱布或纱条。结果８６％（３２／３７）的乳糜瘘发生于手术后前３天。保守治疗的２６侧中１５侧获得痊愈，平均愈合时间为９．７（４～３０）天，１１侧失败，经手术治疗而痊愈；手术缝扎的７侧均一期愈合；切开填塞的４侧，均二期愈合，平均愈合时间为８．５（７～１０）天。结论乳糜瘘经合理地治疗是可以治愈的，并不延长患者的住院时间。对乳糜量每日少于５００ｍｌ的早期乳糜瘘可采用保守治疗；对保守治疗短期内无效及乳糜量每日超过５００ｍｌ的乳糜瘘，应及时采用手术缝扎；对手术后一周及保守治疗超过手术后一周的乳糜瘘，应采用局部切开填塞。

Objective To evaluate the effect of treatment for chylous fistulas after neck dissection, as a means of reasonable option of therapeutic measures.Methods Of 37 chylous fistulas,30 were left-sided and 7 were rightsided. Conservative therapy which included closedwound drainage and local pressure dressing and/or low fat nutritional support was employed in 26 cases, and 50% glucose was injected into the neck basic wound bed in 2 cases,to promoto the chylous fistula healing up.Operative ligation was performed in 7 cases. Openwound and packing in 4 cases. Results Eightysix percent chylous fistula occured from 1 to 3 postoperative days. Of 26 chylous fistulas with conservative management, 15 cases were successfully treated,the mean duration for healing was 9.7 (4～30) days,the remaining 11 cases failed to had and were further treated surgically. Seven cases with operative ligation were successful, and the other 4 cases with open wound and packing had delayed healing, the mean duration was 8.5 (7～10) days . Conclusion The majority of patients with chylous fistulas could be treated reasonablly without increasing the hospital days. The conservative therapy should be employed in cases with a maximal production of chyle below 500 ml a day. Operative ligation should be done early in cases with a maximal production exceeding 500 ml a day and with conservative treatment failure for a few days. The open wound and packing should be used in chylous fistulas persisting for more then 7 days.