Chylous fistula and chylothorax after radical neck dissection.

概要

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This report describes rare postoperative complications occurring after left radical neck dissection in three patients with advanced head and neck cancer. A chylous fistula occurred in the first patient, chylothorax in the second, and both in the third. The high triglyceride content of the drainage demonstrated the presence of chyle in the three patients.<BR>Chylous fistulas occurr due to injury and incomplete ligation of the thoracic duct and lymphatics in the left lower neck. Chylothorax is caused by the breakdown of intrathoracic ducts associated with increased internal pressure arising from ligation of the thoracic duct.<BR>The first patient was reoperated on and ligated because of high fistula output. The other patients were conservatively managed with closed-wound drainage, low fat nutritional support and/or thoracocentesis. Treatment was successful.<BR>Generally, the treatment of chylous fistulas is conservative, including techniques such as local compression, drainage, nutritional management and/or IVH. Reoperation and ligation of the thoracic duct and lymphatics are required when the output is continuous or high. Chylothorax following left radical neck dissection is recommended to be treatedly conservatively.
社団法人日本口腔外科学会の論文