PDF(Pubmed)
Abstract：
Chyle leaks after a neck dissection usually manifest within the immediate postoperative period. However, masked chyle leaks may present as a chyloma months later. A 54-year-old male patient with squamous cell carcinoma of the tongue underwent bilateral neck dissection, subtotal glossectomy, anterolateral thigh flap reconstruction and postoperative radiotherapy. Intraoperatively, chyle leak was encountered in level IV of the left neck. We managed it by ligation of the thoracic duct, application of Tisseel™ sealant (Baxter Inc., Illinois, USA) and one week of prophylactic fat-free feeds. Six months later, an asymptomatic chyloma of the left neck was identified on surveillance MRI. Five weeks after the diagnosis, streptococcal infection developed within the chyloma. However, initiation of fat-free diet, serial aspiration, pressure dressing and antibiotic therapy allowed the chyloma to resolve within two weeks. Further surveillance MRI over three years showed no recurrence of the chyloma. Low-volume chyle leaks may manifest as an occult chyloma. Prophylactic measures cannot replace meticulous ligation of chylous channels in left level IV neck dissection.
摘要：
颈淋巴结清扫后的乳糜渗漏通常在术后即刻出现。然而,几个月后，蒙面的乳糜漏可能会表现为乳糜瘤。一名54岁的男性舌鳞状细胞癌患者接受了双侧颈淋巴结清扫术，舌叶次全切除术,股前外侧皮瓣重建及术后放疗。术中,左颈部IV层有乳糜渗漏.我们通过结扎胸导管来管理它，Tisseel™密封胶的应用(BaxterInc.，伊利诺伊州,美国）和一周的预防性无脂饲料。六个月后,在MRI监测中发现了无症状的左颈部乳糜瘤.确诊后五周,链球菌感染发生在乳糜瘤内。然而,开始无脂饮食，连续抽吸,压力敷料和抗生素治疗使乳糜瘤在两周内消退.三年以上的进一步监测MRI显示乳糜瘤没有复发。少量乳糜漏可能表现为隐匿性乳糜瘤。预防措施不能代替左IV级颈淋巴结清扫术中乳糜通道的精心结扎。
