Abstract：
Chylous fistulas (CF) are rare surgical complications and there is no standard treatment. This study presents the treatment modalities performed on patients who developed CF over a 10-year period. During the observation period, CF developed in 29 patients, 16 of whom were women. The mean age was 55.76± 13.48. Lymphatic duct injury was mostly seen in the abdomen (58.6%) and the most common reason was nephrectomy (20.7%). Extended lymphatic dissection due to malignancy was performed in 82.7% of all cases. Chylous leakage started postoperatively on 3.78±3.94 days (range: 1-19 days). Fasting, total parenteral nutrition (TPN), and somatostatin treatment were applied to all patients, and 75.8% of the fistulas were resolved completely with medical treatment. Surgical ligation of the lymphatic canal was performed in 7 patients. One was not successful and underwent percutaneous embolization of the thoracic lymphatic leakage cavity. All fistulas were resolved in 18.18±10.4 days. The resolution time and hospital stay were significantly higher in thoracic fistulas (p=0.017; p=0.003, respectively). In addition, malignant cases had longer resolution time (32.40±28.72 vs 16.27±11.25, p=0.036) and hospital stay (35.0±29.74 vs 16.25±14.05p= 0.002 respectively) than non-malignant. There was no chylothorax, chylous ascites, or recurrence at 20.55±22.88 months follow-up. Treatment of CF with fasting, TPN, and somatostatin analogs are effective. Other interventions such as surgical ligation with or without fibrin glue and interventional radiology treatments may be considered when conservative treatments fail.
摘要：
乳糜瘘（CF）是罕见的手术并发症，没有标准的治疗方法。这项研究提出了在10年内发展CF的患者的治疗方式。在观察期间,29例患者出现CF，其中16人是妇女。平均年龄为55.76±13.48。淋巴管损伤多见于腹部(58.6%)，最常见的原因是肾切除术(20.7%)。在所有病例中，有82.7％的患者因恶性肿瘤而进行了淋巴清扫。术后3.78±3.94天（范围：1-19天）开始发生乳糜渗漏。禁食,全胃肠外营养（TPN），对所有患者应用生长抑素治疗，75.8%的瘘管通过药物治疗完全解决。7例患者进行了淋巴管结扎术。其中一个未成功，并接受了胸淋巴漏腔的经皮栓塞。所有瘘管在18.18±10.4天内解决。胸瘘的解决时间和住院时间显着增加（分别为p=0.017；p=0.003）。此外,恶性病例的消退时间（32.40±28.72vs16.27±11.25，p=0.036）和住院时间（分别为35.0±29.74vs16.25±14.05p=0.002）。没有乳糜胸,乳糜腹水,随访20.55±22.88个月或复发。空腹治疗CF，TPN,和生长抑素类似物是有效的。当保守治疗失败时，可以考虑其他干预措施，例如有或没有纤维蛋白胶的手术结扎和介入放射学治疗。
