Chyle Fistula after Neck Radical Dissection Using Harmonic Scalpel_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WEI Tao ¹ , ZHANG Guoyong ² , ZHANG Ming ¹ , ZHU Jingqiang ¹

1.Department of Thyriod and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;;
2.Department of General Surgery, Jingyuan Coal Industry Co., Ltd Workers Hospital, Baiyin 730900, Gansu Province, China;

Corresponding?author：

Keywords：

Harmonic scalpel; Neck radical dissection; Chyle fistula

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ObjectiveTo investigate the cause and treatment for chyle fistula after neck radical dissection using harmonic scalpel. MethodsFrom January 2005 to April 2009, 105 patients with thyroid carcinoma underwent thyroidectomy by harmonic scalpel (harmonic scalpel group) and 110 patients with thyroid carcinoma by conventional procedures (conventional group). Postoperative chyle fistula in all the cases was studied retrospectively. ResultsThe incidence of chyle fistula was 5.71% (6 of 105 patients) in the harmonic scalpel group and 0.91% (1 of 110 patients) in the conventional group. The difference was significant between two groups (P lt;0.05). ConclusionsHarmonic scalpel increases the risk of chyle fistula in neck radical dissection. The conventional procedures with exposing and preserving or ligating the thoracic duct can reduce the risk significantly.

Citation： WEI Tao ,ZHANG Guoyong,ZHANG Ming,ZHU Jingqiang. Chyle Fistula after Neck Radical Dissection Using Harmonic Scalpel. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(4): 411-413. doi: Copy

1.	唐億華, 劉學明, 羅文政. 頸部淋巴結清掃術后乳糜瘺的預防及處理 [J]. 現代腫瘤學, 2005, 13(1): 8687.
2.	梁恩虎, 鄒淑娟, 李思忠. 頸淋巴結清掃術后乳糜瘺 [J]. 耳鼻咽喉頭頸外科, 1995, 2(2): 9495.
3.	房居高, 李思忠, 王超, 等. 頸淋巴結清掃手術后乳糜瘺的處理 [J]. 山東醫大基礎醫學院學報, 2002, 16(2): 8586.
4.	呂平, 呂坤章, 王春友, 等. 頸部術后乳糜漏五例的治療體會 [J]. 中華普通外科雜志, 2002, 17(11): 695.
5.	劉善廷, 繆海, 余樹觀. 頸部淋巴結清掃術后乳糜瘺38例治療體會 [J]. 鄭州大學學報(醫學版), 2003, 38(6): 995996.
6.	Gregor RT. Management of chyle fistulization in association with neck dissection [J]. Otolaryngol Head Neck Surg, 2000, 122(3): 434439.
7.	Crumley RL, Smith JD. Postoperative chylous fistula prevention and management [J]. Laryngoscope, 1976, 86(6): 804813.
8.	李正江, 唐平章. 頸廓清術后乳糜瘺的治療及預防 [J]. 中華耳鼻咽喉科雜志, 1998, 33(4): 244246.
9.	魏濤, 李志輝, 朱精強. 超聲刀與傳統方法在開放甲狀腺手術的臨床對比研究 [J]. 中國普外基礎與臨床雜志, 2008, 15（5）: 323326.
10.	張冬坤, 郭朱明, 張詮, 等. 超聲刀在開放性甲狀腺手術中的應用 [J]. 中國耳鼻咽喉頭頸外科, 2006, 13(6): 361371.
11.	張彬, 安常明, 徐震綱, 等. 超聲刀在甲狀腺手術中的應用 [J]. 中國耳鼻咽喉頭頸外科, 2006, 13(6): 365367.
12.	Shemen L. Thyroidectomy using the harmonic scalpel: analysis of 105 consecutive cases [J]. Otolaryngol Head Neck Surg, 2002, 127(4): 284288.
13.	Voutilainen PE, Haglund CH. Ultrasonically activated shears in thyroidectomies: a randomized trial [J]. Ann Surg, 2000, 231(3): 322328.
14.	楊春林, 賀業春, 徐士杰. 胸導管頸部的形態學 [J]. 哈爾濱醫科大學學報, 1982, 31(3): 1013.
15.	陳日亭. 頜面頸手術解剖 [M]. 北京: 人民衛生出版社, 1995: 142.
16.	Gottlieb MI, Greenfield J. Variations in the terminal portion of the human thoracic duct [J]. AMA Arch Surg, 1956, 73(6): 955959.
17.	顧乃群, 朱培志, 趙文潭, 等. 胸導管頸段應用解剖 [J]. 中國臨床解剖學雜志, 1990, 8(2): 7980.
18.	毛增榮, 司心成, 施恩娟, 等. 胸導管的形態結構 [J]. 解剖學報, 1966, 9(3): 349357.
19.	崔功浩. 胸導管頸段的應用解剖 [J]. 浙江醫學, 1983, 5(4): 6163.
20.	沐旭升. 胸導管頸段的應用解剖 [J]. 福建醫學院學報, 1990, 24(1): 9395.
21.	王圣應, 王震寰, 張榮新. 頸段胸導管的臨床應用解剖研究 [J]. 淮海醫藥, 2000, 18(4): 241242.
22.	Van Pernis PA. Variations of the thoracic duct [J]. Surgery, 1949, 26(5): 806809.
23.	Spiro JD, Spiro RH, Strong EW. The management of chyle fistula [J]. Laryngoscope, 1990, 100(7): 771774.
24.	殷之平, 王弘士. 頸部乳糜瘺 [J]. 耳鼻咽喉頭頸外科, 1997, 4(5): 315317.
25.	莫立根, 許堅, 李偉, 等. 頸廓清術后乳糜瘺21例分析 [J]. 廣西醫科大學學報, 2001, 18(6): 864865.
26.	Rollon A, Salazar C, Mayorga F, et al. Severe cervical chyle fistula after radical neck dissection [J]. Int J Oral Maxillofac Surg, 1996, 25(5): 363365.
27.	HarEl G, Lucente FE. Lymphatic drainage system after left radical neck dissection [J]. Ann Otol Rhinol Laryngol, 1994, 103(1): 4648.
28.	de Gier HH, Balm AJ, Bruning PF, et al. Systematic approach to the treatment of chylous leakage after neck dissection [J]. Head Neck, 1996, 18(4): 347351.
29.	Rodgers GK, Johnson JT, Petruzzelli GJ, et al. Lipid and volume analysis of neck drainage in patients undergoing neck dissection [J]. Am J Otolaryngol, 1992, 13(5): 306309.
30.	謝樹奪, 陳文軍, 秦川, 等. 內鏡輔助生物膠黏合治療頸部乳糜瘺二例 [J]. 中華普通外科雜志, 2007, 22(5): 331.

1. 唐億華, 劉學明, 羅文政. 頸部淋巴結清掃術后乳糜瘺的預防及處理 [J]. 現代腫瘤學, 2005, 13(1): 8687.
2. 梁恩虎, 鄒淑娟, 李思忠. 頸淋巴結清掃術后乳糜瘺 [J]. 耳鼻咽喉頭頸外科, 1995, 2(2): 9495.
3. 房居高, 李思忠, 王超, 等. 頸淋巴結清掃手術后乳糜瘺的處理 [J]. 山東醫大基礎醫學院學報, 2002, 16(2): 8586.
4. 呂平, 呂坤章, 王春友, 等. 頸部術后乳糜漏五例的治療體會 [J]. 中華普通外科雜志, 2002, 17(11): 695.
5. 劉善廷, 繆海, 余樹觀. 頸部淋巴結清掃術后乳糜瘺38例治療體會 [J]. 鄭州大學學報(醫學版), 2003, 38(6): 995996.
6. Gregor RT. Management of chyle fistulization in association with neck dissection [J]. Otolaryngol Head Neck Surg, 2000, 122(3): 434439.
7. Crumley RL, Smith JD. Postoperative chylous fistula prevention and management [J]. Laryngoscope, 1976, 86(6): 804813.
8. 李正江, 唐平章. 頸廓清術后乳糜瘺的治療及預防 [J]. 中華耳鼻咽喉科雜志, 1998, 33(4): 244246.
9. 魏濤, 李志輝, 朱精強. 超聲刀與傳統方法在開放甲狀腺手術的臨床對比研究 [J]. 中國普外基礎與臨床雜志, 2008, 15（5）: 323326.
10. 張冬坤, 郭朱明, 張詮, 等. 超聲刀在開放性甲狀腺手術中的應用 [J]. 中國耳鼻咽喉頭頸外科, 2006, 13(6): 361371.
11. 張彬, 安常明, 徐震綱, 等. 超聲刀在甲狀腺手術中的應用 [J]. 中國耳鼻咽喉頭頸外科, 2006, 13(6): 365367.
12. Shemen L. Thyroidectomy using the harmonic scalpel: analysis of 105 consecutive cases [J]. Otolaryngol Head Neck Surg, 2002, 127(4): 284288.
13. Voutilainen PE, Haglund CH. Ultrasonically activated shears in thyroidectomies: a randomized trial [J]. Ann Surg, 2000, 231(3): 322328.
14. 楊春林, 賀業春, 徐士杰. 胸導管頸部的形態學 [J]. 哈爾濱醫科大學學報, 1982, 31(3): 1013.
15. 陳日亭. 頜面頸手術解剖 [M]. 北京: 人民衛生出版社, 1995: 142.
16. Gottlieb MI, Greenfield J. Variations in the terminal portion of the human thoracic duct [J]. AMA Arch Surg, 1956, 73(6): 955959.
17. 顧乃群, 朱培志, 趙文潭, 等. 胸導管頸段應用解剖 [J]. 中國臨床解剖學雜志, 1990, 8(2): 7980.
18. 毛增榮, 司心成, 施恩娟, 等. 胸導管的形態結構 [J]. 解剖學報, 1966, 9(3): 349357.
19. 崔功浩. 胸導管頸段的應用解剖 [J]. 浙江醫學, 1983, 5(4): 6163.
20. 沐旭升. 胸導管頸段的應用解剖 [J]. 福建醫學院學報, 1990, 24(1): 9395.
21. 王圣應, 王震寰, 張榮新. 頸段胸導管的臨床應用解剖研究 [J]. 淮海醫藥, 2000, 18(4): 241242.
22. Van Pernis PA. Variations of the thoracic duct [J]. Surgery, 1949, 26(5): 806809.
23. Spiro JD, Spiro RH, Strong EW. The management of chyle fistula [J]. Laryngoscope, 1990, 100(7): 771774.
24. 殷之平, 王弘士. 頸部乳糜瘺 [J]. 耳鼻咽喉頭頸外科, 1997, 4(5): 315317.
25. 莫立根, 許堅, 李偉, 等. 頸廓清術后乳糜瘺21例分析 [J]. 廣西醫科大學學報, 2001, 18(6): 864865.
26. Rollon A, Salazar C, Mayorga F, et al. Severe cervical chyle fistula after radical neck dissection [J]. Int J Oral Maxillofac Surg, 1996, 25(5): 363365.
27. HarEl G, Lucente FE. Lymphatic drainage system after left radical neck dissection [J]. Ann Otol Rhinol Laryngol, 1994, 103(1): 4648.
28. de Gier HH, Balm AJ, Bruning PF, et al. Systematic approach to the treatment of chylous leakage after neck dissection [J]. Head Neck, 1996, 18(4): 347351.
29. Rodgers GK, Johnson JT, Petruzzelli GJ, et al. Lipid and volume analysis of neck drainage in patients undergoing neck dissection [J]. Am J Otolaryngol, 1992, 13(5): 306309.
30. 謝樹奪, 陳文軍, 秦川, 等. 內鏡輔助生物膠黏合治療頸部乳糜瘺二例 [J]. 中華普通外科雜志, 2007, 22(5): 331.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Chyle Fistula after Neck Radical Dissection Using Harmonic Scalpel

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