- 期刊
以手術修補頸部淋巴廓清手術後乳糜漏－病例報告
Surgical Intervention of Cervical Chyle Leakage after Radical Neck Dissection-A Case Report
摘要
治療頭頸部癌而進行根除式頸部淋巴廓清術時，可能會傷及左側胸管或右側淋巴管而導致乳糜外漏。大量的乳糜外漏會造成病患水分、電解質和蛋白質的流失，因而延遲傷口癒合及延長住院時間。嚴重者更可能導致休克，甚至死亡。本病例報告一位口腔癌患者，在頸部淋巴廍清術中就發現有乳糜外漏，雖然立即將胸管損傷部位利用鄰近軟組織縐摺並用可吸收線縫合覆蓋住胸管損傷部位，術後仍舊發生嚴重乳糜外漏的現象。雖以低負壓抽吸持續不斷洩漏的乳糜積液、並在鎖骨上方以沙袋加壓、注射硬化劑、全靜脈營養等保守性方法治療，但都無法控制乳糜外漏，最後才以手術方式修補及以取自腹部的dermal fat graft填壓才成功治療乳糜外漏的併發症。
並列摘要
One of the complications of radical neck dissection is chylous fistula. Chylous fistula may increase the morbidity of patient and prolonged management. Unfortuntately, the optimal managements of chylous fistula are still very controversial. We present our experience with managements of high out-put chylous fistula. In this case, the thoracic duct injury was found intraoperatively and then immediately ligated with adjacent soft tissues by absorbable sutures. However, the post-operative chylous fistula still happened. Initially, the conservative measures were applied to stop the fistulas without any success. Reoperation and repair with abdomen dermal fat graft was successfully employed to stop chylous fistula.