喉癌患者颈廓清术并发乳糜漏20例临床分析

Clinical analysis of chylous fistula after the radical neck dissection in 20 cases of laryngeal carcinoma

目的探讨喉癌患者行颈部淋巴结廓清术中、术后并发乳糜漏的诊断和治疗疗效。方法对西安交通大学第一附属医院2007-02~2013-02接受水平半喉切除或全喉切除术＋双侧颈部淋巴结廓清术并发乳糜漏的患者进行回顾性分析。结果在发生乳糜漏的喉癌患者中,11例为术中发现并行手术治疗,7例为术后发现行保守治疗,2例为术后保守治疗无效而行二次手术治疗,20例乳糜漏患者均获得痊愈。结论喉癌颈廓清手术应熟悉颈根部胸导管的应用解剖,术中、术后应仔细观察是否有淋巴漏的发生以明确诊断,根据具体情况采取相应的治疗方法可获得满意疗效。

Objective To explore the diagnosis and treatment of the chylous fistula during and after the radical neck dissection in patients with laryngeal cancer. Methods A retrospective analysis was performed in 20 cases of chylous fistula who underwent the horizontal hemilaryngectomy or total laryngectomy combined with neck dissection in the First Affiliated Hospital of Xi ＇ an Jiaotong University. Results Of 20 cases, 11 cases were found during the operation and received the intraoperative treatment ,7 cases were found after the operation and received the conservative treatment and 2 cases received the second surgery after ineffective conservative treatment. Twenty cases of chylous fistula were fully cured. Conclusion For the neck dissection operation in laryngeal carcinoma patients, the applied anatomy of the thoracic duct in the root of neck should be well mastered, the chylous fistula should be carefully observed and definitely confirmed during and after the operation, and the good effects could be achieved after the corresponding treatment method based on the concrete circumstance.