Use of Tie-Over Suture Technique in Management of Intractable Chylous Leakage after Neck Dissection-A Case Report

頸部淋巴廓清後之乳糜外漏是個不常見的併發症，但會引起很多問題。通常它可以透過飲食控制的方式行保守治療。一旦保守治療無效，通常需要儘快手術治療來避免更多傷害。由於術後的組織相當脆弱以及組織界面不清楚，要將在頸部的胸管探查出來綁紮或在其上行直接縫合並不容易。在此我們報告一個頸部淋巴廓清後之頑固性乳糜外漏而對保守治療無效的案例。在術後第11天，雖經保守治療，仍然持續大量乳糜外漏。我們行頸部探查手術但是無法找到胸管。我們將縫線及小棉墊片固定於乳糜外漏附近較健康的組織，再用止血棉Surgicel(上标 TM)填塞在外漏處並用捆紮的方式固定,成功地止漏。術後並無局部乳糜外漏復發或產生乳糜胸。我們認為運用捆紮縫合方式可列入治療頸部淋巴廓清後頑固性乳糜外漏的考慮，尤其是在組織脆弱及界面不清楚的情況下。

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並列摘要

Chylous leakage after radical neck dissection is uncommon and may cause many complications. Mostly, it can be handled conservatively with diet control. When diet control fails, surgical intervention is then indicated to stop it as soon as possible to prevent further damage. Because the tissue is friable and unhealthy, exploration of the thoracic duct in the neck portion for tie-off or oversewing is not easy. Herein we present a case of chylous leakage after radical neck dissection in a patient of extensive left buccal cancer post wide excision. The chylous leakage was refractory to conservative treatment. The neck was explored on the 11(superscript th) day postoperatively and the thoracic duct couldn't be identified. The chylous leakage was stopped successfully with pledgets and Surgicel(superscript TM) using a tie-over suture technique. Neither recurrence of leakage nor chylothorax developed. We suggest that the tie-over technique is a good alternative to manage intractable chylous leakage after radical neck dissection, especially when the surrounding soft tissue is friable and tissue plane is not clear.

並列關鍵字

chylous leakage ； neck dissection ； tie-over technique

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Use of Tie-Over Suture Technique in Management of Intractable Chylous Leakage after Neck Dissection-A Case Report

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