手術後乳糜滲漏之警覺及成功之外科處置- 兩病例報告

Awareness and Successful Surgical Treat ment of Postoperat ive Chyle Leaks- Report of Two Cases

手術後乳糜滲漏，臨床案例不多，而乳糜長期滲漏會導致體內營養及液體流 失，造成營養障礙和延長住院時間。本文中分享兩個案例，皆因癌症手術清除淋巴 結，而產生乳糜滲漏合併症。第一位是接受左頸淋巴結清除而於左頸深處產生乳糜 滲漏，第二位是接受胸腔鏡右上肺葉切除手術及縱膈腔淋巴結清除手術而發生乳糜 胸。這兩位案例的合併症之處置，皆是在全身麻醉引導下放置鼻胃管，打開傷口， 管灌全脂牛奶或橄欖油後，找到乳糜滲漏處；此處原是先前手術當中清除淋巴結的 部位。經由縫合，直至滲漏停止。針對乳糜胸之個案，為求慎重，不僅縫合乳糜滲 漏處，同時執行乳糜導管結紮手術。這兩位病人，滲漏合併症解決後數天順利出院。

 

Postoperative chyle leaks are rare. Prolonged chyle leaks usually result in loss of fluid and nutrition, poor wound healing, and longer hospital stays. We present two cases of postoperative chyle leaks following lymph node dissection.The first case underwent ablation of the left neck lymph nodes, resulting in chyle leaks in the left deep neck. The second case had chylothorax following a thoracoscopic right upper lobectomy of the lung and mediastinal lymph node dissection. To detect chyle leaks in the region of lymph node dissection, we supplied milk or olive oil via the nasogastric tube following general anesthesia. The chyle leaks usually stopped after suture ligation. For security, the thoracic duct was also ligated in case of chylothorax. Both patients were uneventfully discharged.