颈清扫乳糜漏的术中预防  

Prevention and treatment for chylous fistula in the neck dissection

作　　者：储康宁[1] 刘业海[1] 赵益[1] 杨克林[1] 吴静[1] 陆地红[1] 李亦凡[1] 

机构地区：[1]安徽医科大学第一附属医院耳鼻咽喉头颈外科,安徽合肥230022

出　　处：《中国耳鼻咽喉头颈外科》2012年第4期169-171,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨颈清扫术中乳糜漏的预防及治疗措施。方法回顾性分析我科行IV区颈清扫术350例(420侧)的临床资料。27例术中乳糜漏分别发生于28侧颈清扫术患者,其中左侧19例,右侧7例,双侧出现为1例。发现时立即对乳糜漏口进行结扎,必要时连同游离胸锁乳突肌块或胸锁乳突肌瓣一起缝扎,呼吸气囊胸腔加压后至无清亮液体或乳白色液体外溢为止,术后锁骨上窝加压包扎。结果 1例左侧发生术后乳糜漏,采用负压吸引、局部加压及低脂饮食等保守治疗2周后痊愈。结论熟悉解剖、提高手术技巧是减少颈清扫术后乳糜漏发生的关键。术中发现乳糜立即采取相应的处理是预防术后乳糜漏的有效措施。OBJECTIVE To discuss the prevention and treatment of chylous leakage in neck dissection.METHODS There were 350 cases（420 laterals）during August 2004 to August 2011 included in our study,each case had neck dissection involving lymph node of level IV.Chylous leakage occurred in 28 laterals of 27 cases during surgery,19 cases occurred on left and 7 cases on right,while one cases involved in both laterals.We ligated the fistula immediately and sutured the sternomastoid muscle together if needed.After pressurizing of chest breathing bag,we ensured the reparation of the chylous leakage and pressure bandaging were applied on supraclavicular fossa after surgery.RESULTS Chylous leakage occurred in one of the 27 cases after neck dissection.And after vacuum aspiration,pressurized bandage and low fat diet therapy for two weeks,the chylous fistula was cured.CONCLUSION The key to reduce the incidence of chylous leakage is to be familiar with the anatomy,and to improve the operation skills.If the chylous leakage occurred during surgery,appropriate treatment should be done to prevent the chylous leakage,and chylous leakage can be cured after positive therapy.

关 键 词：颈淋巴结清扫术 手术后并发症 治疗 综合预防 乳糜漏 

分 类 号：R730.5[医药卫生—肿瘤]