頸部淋巴廓清術中意外傷及胸管－病例報告

Accident Damage of the Thoracic Duct in Radical Neck Dissection (case report)

李錦揚(C Y Lee) ； 季曉敏(S M Ghi) ； 劉遵銘(Z M Liou)

《中華民國口腔顎面外科學會雜誌》 8卷2期 (1997/09) Pp. 71-76

https://doi.org/10.7104/CJOMS.199709.0071

摘要

乳糜瘻管(chyle fistula)是頸部淋巴廓清術(radical neck dissection)中少見但極爲嚴重的併發症，而伴隨有乳糜胸(chylothorax)的情況更少。因胸管(thoracic duct)在解剖上之因素，故瘻管多發生於左側，一般處理原則是採取下頸部之敷布加壓(pressure dressing)、低脂營養食物之給予，及乳糜之抽吸引流等保守性治療。本病例爲一左側臼齒後區之口腔癌患者，於頸部手術中意外傷及胸管，導致術後乳糜瘻管，始以保守性治療但失敗，最後以手術曝露傷口結紮胸管。文獻報告指出對於每天大於600cc的高流量廔管或超過二星期的長期廔管，則需再進行胸管之結紮手術。

關鍵字

頸部淋巴廓清術 ； 乳糜瘻管 ； 乳糜胸 ； 胸管

並列摘要

Chyle fistula of the neck is an extremely rare but serious complication of neck operative procedures. Chylothorax following chyle fistula is much less. Most chyle fistula occur on the left side of the neck because of the anatomy of the thoracic duct. The principles of treatment consists of use of low fat (medium chain triglycerides) diet, aspiration and pressure dressing on the supraclavicular area. If the above measures are not effective then surgical re-exploration is necessary. A 67-year-old male presented with a squamous cell carcinoma in the left retromolar area. Wide excision of oral lesion was performed, with left radical neck dissection, marginal resection of left mandible and DP flap reconstruction. During the neck dissection, the thoracic duct was damaged accidentally, followed by cervical chyle fistula on the second postoperative day. Therapy was started with the initial conservative treatment but failed, on postoperative day 21, he received the surgical intervention of ligation of the thoracic duct. Postoperatively, the leakage stopped. Retrospective literature review indicates that the reoperation is indicated while conservative treatment of a chyle fistula is likely to fail when fistula output exceeds 600cc per day and drainage of lesser amounts continues for more than two weeks.